2021 Volume 57 Issue 3 Pages 678-683
A 7-month-old boy had repeated convulsions with hypoglycemia and hyperinsulinemia since 4 months of age, and he was referred to our hospital on the suspicion of congenital hyperinsulinism (CHI). We diagnosed him as having focal CHI in the tail of the pancreas, on the basis of the accumulation of PET and the presence of a paternal single allele mutation in the ATP-dependent K-channel gene. Owing to his resistance to medical treatment, a laparoscopically assisted partial distal pancreatectomy was performed. The lesion was identified by laparoscopic observation and palpation through a small laparotomy. As continuous octreotide subcutaneous injection was not required immediately after resection without hypoglycemia, we judged that a complete resection was achieved. Histopathological analysis showed hyperplasia of pancreatic endocrine cells. Postoperatively, medication and carbohydrate load were no longer required to maintain blood glucose, and he was discharged from the hospital on postoperative day 9. Continuous glucose monitoring in the first month postoperatively showed no hypoglycemia, and the patient’s follow-up was terminated. Focal-type CHI can be treated by surgery with early relief of symptoms without sequelae. In this patient, we effectively used laparoscopy to identify a small and superficial lesion and performed a complete resection through a small laparotomy less invasively.
