A Case Report of Duodenal Gastrinoma which Caused Anastomotic Ulcer due to Vagal Gastric Acid Hypersecretion

Hirofumi Ota, Nobuhisa Ueda, Seiichi Matsunaga, Yoshiichi Maeura, Eiji Akizuki, Takuji Sugimoto, Kazuyoshi Tomita

Department of Surgery, Shinsenri Hospital

A 50-year-old woman following gastric ulcer underwent resection of the jejunum and distal gastrectomy as an emergency operation for jejunal perforation in August 1992. After the operation, gastrinoma was suspected because the fasting serum gastrin level was 1224 pq/m\ and the secretin provocation test was positive. Ultrasonography and CT scanning failed to reveal the presence of any tumor in the pancreatic region. We performed a selective arterial secretin injection test, and confirmed that microgastrinomas were present in the feeding region of gastroduodenal artery. Pancreatoduodenectomy was performed in December 1992. We confirmed the radicality with an intraoperative secretin provocation test, and carried out reconstruction in a manner that preserved the gastric remnant. Although the serum gastrin level remained normal, the anastomotic stoma became stenotic by anastomotic ulcer. Resection of the stenotic part and truncal vagotomy were performed in order to reduce vagal gastric hypersecretion. Recently a stomach-preserving method has been chosen due to the develolpment of the localization method for gastrinomas. When we select the stomach-preserving operation, we should add truncal vogotomy considering the possibility of anastomotic ulcer due to vagal gastric hypersecretion.

Key words
duodenal gastrinoma, vagal gastric acid hypersecretion, anastomotic ulcer

Reprint requests
Hirofumi Ota Department of Surgrey II, Osaka University Medical School
2-2 Yamadaoka, Suita, 565 JAPAN

Accepted
February 14, 1996

To read the PDF file you will need Abobe Reader installed on your computer.