Abstract
Two cases of insulinoma experienced at our department are reported.
Case 1: A 50-year-old female was referred to our hospital because of hypoglycemic attack. The fasting test was positive and IRI/blood sugar ratio, 0.37. As PTPC yielded a prominent elevation in IRI at the pancreatic head, tumor enucleation was performed with a diagnosis of insulinoma. After the enucleation was performed, intraoperative portal venous sampling revealed the degradation of IRI.
Case 2: A 54-year-old female was admitted to our hospital because of hypoglycemic episode. The fasting test was positive with the ratio of IRI/blood sugar of 1.94. A tumor was identified at the body of pancreas using CT and angiography. Wedge-shaped resection of the tumor was done under a diagnosis of insulinoma. After the resection no remnant tumors were noticed by intraoperative US.
Insulinomas are used to being found with small sizes, and some are reported being multiple or ectopic. Therefore the preoperative and/or intraoperative tumor localization is important and it should be identified carefully. Each method of radiological examination and portal venous sampling are useful not only to localize the tumor but to select the optimal surgical procedure and to estimate the complete resection.
