A Case of Multiple Insulinomas of the Residual Pancreas after Distal Pancreatectomy for Insulinomas 7 years Ago

Masayuki Hatanaka, Toshide Imaizumi, Takashi Hatori, Toshiaki Nakasako, Nobuhiko Harada, Kazuhiro Akiyama, Satoshi Katagiri, Fujio Hanyu, Ken Takasaki

Department of Gastroenterological Surgery, Tokyo Women's Medical College

A 45-year-old woman underwent distal pancreatectomy for benign insulinomas of the pancreatic body and tail in 1987. In August 1994, she complained of nausea or palpitation after meals and her blood sugar on fasting was very low (51 mg/dl). Ultrasonography revealed two tumors of the residual pancreas with diameters of 15 mm (body) and 5 mm (head) Both tumors were enhanced by dynamic CT and were found to be hypervascular by angiography. IRI levels of the portal system in the pancreatic head and body were shown to be elevated by percutaneus transhepatic portal vein sampling. We enucleated three insulinomas of the residual pancreas (one was detected by intraoperative US) that occurred at different times. Intra operative Quick IRI monitoring was very useful for confirmation of tumor excision. All three tumors were diagnosed as insulinomas by pathological findings obtained by immunological staining. She has been followed up for 12 months without hypoglycemia.

Key words
multiple insulinomas, percutaneus trans hepatic portal vein sumpling, intra-operative Quick IRI monitoring

Reprint requests
Masayuki Hatanaka Department of Gastroentelorogical Surgery, Tokyo Women's Medical College
8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
July 10, 1996

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