1990 Volume 51 Issue 3 Pages 578-583
A 36-year-oid woman was hosptialized with the chief complaint of sudden episodes of unconsciousness. Endocrinological tests suggested the existence of insulinoma. Blood samples collected from the tail of the pancreas by percutaneous transhepatic portal vein catheterization (PTPC) had high levels of immunoreactive insulin (IRI) and C peptide, showing that the tumor was at the tail of the pancreas, which was confirmed by intraoperative sonography. The tumor was extirpated and the measurement of blood glucose and IRI levels during surgery disclosed that the removal was complete. Antibiotics, aprotinin, and hyperalimentation were used instead of surgical treatment for pancreatic juice leakage after surgery because the main pancreatic duct was not injured. The leakage ended 14 weeks after surgery. PTPC and intraoperative sonography are useful for identification of the location of insulinomas. Intraoperative measurements of blood glucose and IRI are useful for confirmation whether the removal of a tumor is complete or not. Postoperative pancreatic juice leakage can be treated conservatively if there is no injury in the main pancreatic duct and if satisfactory drainage for the leaking juice is available.
