A Case of Vasoactive Intestinal Polypeptide Secreting Pancreatic Tumor Recovered from Severe Circulation and Renal Disorders by Use of Artificial Support Including Continuous Hemodialysis and Filtration Followed by Distal Pancreatectomy

Tetsuro Hirose, Mitutaka Nishimura, Daisuke Azuma¹⁾, Norihiro Takahashi¹⁾, Ryoya Yamaoka, Katsutaro Yasuda, Yasuhide Ishikawa, Toshihide Shimada²⁾, Tetsuro Ogino²⁾ and Tomohiko Nishihira

Department of Gastroenterological Surgery, Department of Renal Medicine¹⁾ and Department of Pathology²⁾, Takamatsu Red Cross Hospital

A 60-year-old woman administered intravenous fluid and electrolyte replacement one year for refractory diarrhea, was hospitalized several times for hypokalemia and general muscle weakness. Computed tomography showed a 10 cm pancreatic body tumor. She was referred for hemodialysis after her diarrhea caused renal failure. Suspecting vasoactive intestinal polypeptide-secreting tumor, we attempted unsuccessfully to ease the diarrhea with loperamide hydrochloride and octreotide acetate. Hemodialysis, then continuous hemodialysis with filtration, was introduced against circulatory failure, severe acidosis, and renal failure. Distal pancreatectomy was done as soon as high serum vasoactive intestinal polypeptide was identified. Diarrhea subsided within 2 days of surgery, and she was removed from life-support equipment. Even under life-threatening conditions requiring artificial organ support, including continuous hemodialysis and filtration, tumor resection is the only way to enable patients to resume regular lives.

Key words
VIP (vasoactive intestinal peptide), WDHA syndrome (the watery diarrhea, hypokalemia, achlorhydria syndrome), CHDF (continuous hemodialysis and filtration)

Reprint requests
Tetsuro Hirose Depatartment of Gastroenterological Surgery, Takamatsu Red Cross Hospital
4-1-3 Bancyo, Takamatsu, 760-0017 JAPAN

Accepted
October 28, 2009

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