A Case Report of Zollinger-Ellison Syndrome Arising from the Duodenum

Keishi Kondo, Mitsuo Kusano, Akihumi Yamashita, Takashi Munakata, Shin-ichi Kasai, Hidetaka Ebata, Michio Mito, Hiroshi Kurokawa*, Kazumichi Harada*

The Second Department of Surgery, *The Third Department of Internal Medicine, Asahikawa Medical College

A case of malignant gastrinoma arising in the duodenum is reported. The patient was a 57-year-old man who underwent subtotal gastrectomy and Billroth II anastomosis following a diagnosis of duodenal ulcer. A month later epigastric pain and hematemesis developed. Because of suspected gastrinoma, he was referred to our hospital for evaluation and treatment. His fasting serum gastrin concentration was 600 pg per ml, and the results of intravenous secretion and glucagon injection tests were consistent with gastrinoma. Ultrasonography and CT scanning failed to reveal the presence of any tumor in the pancreatic region. Selective angiography of the common hepatic artery and percutaneous transhepatic venous sampling of gastrin suggested the presence of an 8-mm mass in the duodenum or the head of the pancreas. At surgery no tumor was found in the duodenum or pancreas, and total gastrectomy, excision of the duodenal remnant and dissection of the lymph nodes behind the head of the pancreas were performed. A tumor was found in the duodenal remnant. Microscopically, the tumor and the lymph node lesions were diagnosed as gastrinoma and metastases. Two days after excision of the tumor and the lymph nodes the serum gastrin level had dropped to 45 pg per ml. The patient is alive without recurrence five years after the second operation.

Key words
Zollinger-Ellison syndrome, duodenal gastrinoma, lymph node metastasis of gastrinoma

Reprint requests
Keishi Kondo The Second Department of Surgery, Asahikawa Medical College
4-5, Nishikagura, Asahikawa, 078 JAPAN

Accepted
April 17, 1991

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