A Case of Syndrome of Inappropriate Secretion of Antidiuretic Hormone Complicated after Surgery for Pancreatic Head Cancer

Yuuki Takeuchi, Tomoki Fukuoka, Hideki Takami, Hiroki Murakami and Takaya Miwa

Surgical Service, Nagoya Memorial Hospital

We report the complication of severe syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a 58-year-old man with pancreatic head cancer with pancreaticobiliary maljunction. We conducted pylorus-preserving pancreatoduodenectomy (D2, type II rebuilding, t3n2M0 Stage IVa), after which the man recovered, but suffered delayed oral intake due to a delayed gastric emptying. He suffered bacteriologic enteritis and was given a proton pump inhibitor (PPI) to prevent gastric juice loss on postoperative day (POD) 17. On POD 29, he suffered pyrexia and disturbance of consciousness developing into a semicoma state. Detailed examinations showed him to be severely hyponatremic with serum sodium levels of 104 mEq/L yielding a diagnosis of SIADH. Because of sepsis, water restriction was difficult, so we treated his SIADH by forced supplementation of sodium with furosemide and demethylchlortetracycline hydrochloride. He recovered on POD 44, i.e., day 15 after SIADH treatment was started. SIADH is caused, for example, by a tumor or medication, and requires caution in treatment, because it is difficult to diagnose early and it worsens after major surgery. This finding also suggests the possibility of PPI influence in SIADH development.

Key words
SIADH, pancreatic head cancer, postoperative complication

Reprint requests
Yuuki Takeuchi Surgical Service, Nagoya Memorial Hospital
4-305 Hirabari, Tenpaku-ku, Nagoya, 468-8520 JAPAN

Accepted
December 17, 2008

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