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Case Reports
. 2016 Jun;95(26):e3928.
doi: 10.1097/MD.0000000000003928.

Intraoperative portal vein insulin assay combined with occlusion of the pancreas for complex pancreatogenous hypoglycemia: Two cases report

Zhiying Yang  1 , Haidong Tan, Yongliang Sun, Shuang Si, Li Xu, Xiaolei Liu, Liguo Liu, Wenying Zhou, Jia Huang
Affiliations
Case Reports

Intraoperative portal vein insulin assay combined with occlusion of the pancreas for complex pancreatogenous hypoglycemia: Two cases report

Zhiying Yang et al. Medicine (Baltimore). 2016 Jun.

Abstract

Intraoperative localization and confirmation of complete resection of the hypersecreting tissue are the 2 main challenges in the management of pancreatogenous hypoglycemia. Here, we report our experience with intraoperative portal vein insulin assay combined with occlusion of the pancreas in the management of pancreatogenous hypoglycemia. Clinical courses of 2 patients with biochemical evidence of a pancreatogenous hypoglycemia were studied. The preoperative diagnosis was multiple endocrine neoplasia 1 (MEN-1) and nesidioblastosis, respectively. Rapid intraoperative portal vein insulin assay combined with occlusion of the pancreas was used to localize and confirm complete excision of the hypersecreting tissue. Hypoglycemia was successfully treated in both the patients. In the MEN-1 patient, 2 small tumors in the head of pancreas were not resected, as they were deemed noninsulin secreting by intraoperative portal vein insulin assay, thus avoiding a total pancreatectomy. In the patient with nesidioblastosis, using intraoperative portal vein insulin assay combined with occlusion of the pancreas, an appropriate amount of pancreatic tissue was resected thereby avoiding recurrence and diabetes. This technique may be of particular value in patients with complex conditions such as MEN-1 and nesidioblastosis, to localize and achieve complete resection of hypersecreting pancreatic tissue.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The preoperative magnetic resonance imaging of Case 1 showed multiple tumors in the whole pancreas gland. Yellow arrows: the tumor localized in neck of pancreas; red arrows: the multitumors localized in pancreas.
Figure 2
Figure 2
The intraoperative insulin assay of peripheral and portal vein and operative decisions for Case 1. INS = insulin, GLU = blood glucose.
Figure 3
Figure 3
The intraoperative insulin assay of peripheral and portal vein and operative decisions for Case 2. INS = insulin, GLU = blood glucose.
See this image and copyright information in PMC

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