Abstract
To date, no precise methods of preoperatively localizing multiple insulinomas or intraoperatively confirming their complete removal have been established. We describe herein the effectiveness of combining the selective arterial calcium injection (SACI) test to locate tumors preoperatively, with intraoperative continuous blood glucose monitoring (IOBGM) to confirm their complete removal. During the 8-year period from 1990 to 1997, we experienced two patients with multiple insulinomas. The first patient required resection of a residual tumor in the remnant pancreas for persistent hyperinsulinemia after a distal pancreatectomy performed under conventional diagnostic procedures. In the second patient, a SACI test was performed in addition to other diagnostic imaging procedures, and while computed tomography scan, endoscopic ultrasonography, and arteriography demonstrated multiple tumors in the body and tail of pancreas, the SACI test suggested that there were also tumors in the head of pancreas. Intraoperative ultrasonography showed a tumor measuring 5 mm in diameter on the surface of the head of the pancreas, apart from the multiple tumors in the body and tail of the pancreas. Complete removal of all tumors was assessed by the hyperglycemic rebound after resection of the tumors, determined by IOBGM. Based upon our experience, we believe that the SACI test and IOBGM are helpful for establishing precise localization and achieving complete removal of multiple insulinomas.
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References
Hammond PJ, Jackson JA, Bloom SR (1994) Localization of pancreatic endocrine tumours. Clin Endocrinol 40:3–14
Moore NR, Rogers CE, Britton BJ (1995) Magnetic resonance imaging of endocrine tumors of pancreas. Br J Radiol 68:341–347
Rosch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MVJ, Yasuda K, Heyder N, Palazzo L, Dancygier H, Schusdziarra V (1992) Localization of pancreatic endocrine tumors by endoscpic ultasonography. N Engl J Med 326:1721–1726
Nakamura R, Kobari M, Takeda K, Kimura M, Matsuno S (1994) Role of intraoperative ultrasonography in the surgical management of insulinoma. J Hep Bil Pancr Surg 1:535–541
Lo C-Y, Lam K-Y, Kung AWC, Lam KSL, Tung PHM, Fan S-T (1997) Pancreatic insulinomas. Arch Surg 132:926–930
Vink AI, Delbridge L, Moattari R, Cho K, Tompson N (1991) Transhepatic portal vein catheterization for localization of insulinomas: a 10-year experience. Surgery 109:1–11
Doppmann JL, Miller DL, Chang R, Shawker TH, Gorden P, Norton JA (1991) Insulinomas: localization with selective intraarterial injection of calcium. Radiology 178:237–241
Imamura M, Shimada Y, Kato M, Dori R, Okada N, Hashimoto M (1994) Usefulness of selective arterial calcium injection test and secretin test in patients with insulinomas. J Hep Bil Pancr Surg 1:530–534
Stefanini P, Carboni M, Patrassi N, Basoil A (1974) Beta-islet cell tumors of the pancreas: results of a study on 1067 cases. Surgery 75:597–609
Thompson GB, Service FJ, van Heerden JA, Carney JA, Charboneau JW, O’Brien PC (1993) Reoperative insulinomas, 1927 to 1992: an institutional experience. Surgery 114:1196–1206
Imamura M, Takabayashi K, Adachi H, Minematsu S, Shimada H, Naito M, Suzuki T, Tobe T, Azuma T (1987) Usefulness of selective arterial secretin injection test for localization of gastrinoma in Zollinger-Ellison syndrome. Ann Surg 205:230–239
Gaeke RF, Kaplain EL, Rubenstein A, Starr J, Burke G (1975) Insulin and proinsulin release during calcium infusion in a patient with islet cell tumor. Metabolism 24:1029–1034
Imamura M, Tobe T (1990) Localization of pancreatic endocrine tumors with arteriography, percutaneous transhepatic portal vein blood sampling and selective arterial secretin injection test (in Japanese with English abstract). Diagn Imag Abdomen 10:865–871
Kung AWC, Chan FL, Tam SCF, Lam KSL (1992) Case report: localization of occult insulinoma by intra-arterial stimulation with calcium and venous sampling technique. Clin Radiol 46:55–56
Jaklic BR, Miller DL, Ghosh BC (1995) Selective calcium stimulation test for locating insulinoma. J Surg Oncol 58:208–209
Tutt GO, Edis AJ, Service FJ, van Heerden JA (1980) Plasma glucose monitoring during operation for insulinoma: a critical reappraisal. Surgery 88:351–356
Hatanaka M, Imaizumi T, Hatori T, Nakasako T, Harada N, Akiyama K, Katagiri S, Hanyu F, Takasaki K (1996) A case of multiple insulinomas of the residual pancreas after distal pancreatectomy for insulinomas 7 years ago (in Japanese with English abstract). Jpn J Gastroenterol Surg 29:2299–2303
Yano S, Sumi S, Nio Y, Ooishi T, Kawabata Y, Minari Y, Tamura K (1997) Insulinoma: selective arterial calcium injection performed to confirm localization and complete resection. J Hep Bil Pancr Surg 4:340–345
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Haji, S., Nomura, H., Yasuda, K. et al. Combining the selective arterial calcium injection test and intraoperative blood glucose monitoring for multiple insulinomas: Report of two cases. Surg Today 30, 537–540 (2000). https://doi.org/10.1007/s005950070123
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DOI: https://doi.org/10.1007/s005950070123