Case report: Anesthesia management for surgical treatment of glucagonoma with symptom of characterized necrolytic migratory erythema

Abstract

Background: The anesthetic management of patients with glucagonoma is complicated by a number of factors including glucose fluctuation, characterized necrolytic migratory erythema in oral and pharyngeal, which may lead to an unexpected difficult airway.

Case presentation: Herein we describe the anesthetic considerations and management of a 47-year-old adult with glucagonoma, who presented for a laparoscopic splenectomy and distal pancreatectomy procedure.

Conclusion: This report details fiberoptic intubation in an adult with glucagonoma and necrolytic migratory erythema. We recommend that this approach be considered in patients with glucagonoma and severe necrolytic migratory erythema undergoing general anesthesia.

Keywords: anesthesia management; difficult airway; fiberoptic intubation; glucagonoma; necrolytic migratory erythema.

Figure 1

Cutaneous manifestations of necrolytic migratory erythema. Necrolytic migratory erythema distributed on the patient’s face (A), hands (B), elbows (C), and sacrum (D). Figure E shows glossitis, stomatitis, or cheilitis.

Figure 2

The CT scan of glucagonoma (The red arrow shows the location of the tumor. The two images show the arterial phase of the enhanced CT scan and the portal phase of the enhanced CT scan.)

Figure 3

Oropharyngeal cavity under fiberscope. (A) shows the narrow pharynx; (B) shows glottis under fiberoptic bronchoscope; (C) shows the carina; (D) shows a tracheal catheter placed in the appropriate position within the airway.

Figure 4

Pancreatic glucagonoma tumor body (A); Histological examination of the mass showing an (B) (Hematoxylin and Eosin (H&E) staining of tissue section, showing well-defined alpha-cell pancreatic tumor cellular architecture).