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Road accident due to a pancreatic insulinoma: a case report.

Parisi A, Desiderio J, Cirocchi R, Grassi V, Trastulli S, Barberini F, Corsi A, Cacurri A, Renzi C, Anastasio F, Battista F, Pucci G, Noya G, Schillaci G - Medicine (Baltimore) (2015)

Bottom Line: Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor.Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences.Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.

View Article: PubMed Central - PubMed

Affiliation: From the Unit of Digestive and Liver Surgery (AP, JD, VG, ST, AC), Santa Maria Hospital, Terni; Department of General and Oncologic Surgery (RC, FB, AC, CR, GN), University of Perugia, Perugia; Unit of Internal Medicine (FA, FB, GP, GS), Santa Maria Hospital, Terni; and Department of Medicine (FA, FB, GP, GS), University of Perugia, Perugia, Italy.

ABSTRACT
Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of loss of consciousness in a patient with pancreatic insulinoma. In the previous months, the patient had occasionally reported nonspecific symptoms. During hospitalization, endocrine examinations were compatible with an insulin-producing tumor. Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor. The patient underwent a robotic distal pancreatectomy with partial omentectomy and splenectomy. Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences. Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.

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Abdominal magnetic resonance imaging.
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Figure 1: Abdominal magnetic resonance imaging.

Mentions: Endocrine tests excluded other causes of hypoglycemia, such as hypopituitarism and adrenal insufficiency. An abdominal magnetic resonance scan showed an 11-mm nodule of the tail of the pancreas, a normal pancreatic duct, and no evidence of retroperitoneal lymphadenopathy (Figure 1). An abdominal contrast-enhanced CT confirmed the presence of a slightly hypervascular 11-mm solid nodule of the tail of the pancreas, with no other relevant findings (Figure 2). A diagnosis of pancreatic insulinoma was made, and the patient was transferred to the surgery unit for surgical treatment. Informed consent was obtained from the patient, then a robotic distal pancreatectomy with partial omentectomy and splenectomy was performed (Ethics Committee approval was not required in this case, since robotic surgery falls within common clinical practice in Italy for this indication).


Road accident due to a pancreatic insulinoma: a case report.

Parisi A, Desiderio J, Cirocchi R, Grassi V, Trastulli S, Barberini F, Corsi A, Cacurri A, Renzi C, Anastasio F, Battista F, Pucci G, Noya G, Schillaci G - Medicine (Baltimore) (2015)

Abdominal magnetic resonance imaging.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554003&req=5

Figure 1: Abdominal magnetic resonance imaging.
Mentions: Endocrine tests excluded other causes of hypoglycemia, such as hypopituitarism and adrenal insufficiency. An abdominal magnetic resonance scan showed an 11-mm nodule of the tail of the pancreas, a normal pancreatic duct, and no evidence of retroperitoneal lymphadenopathy (Figure 1). An abdominal contrast-enhanced CT confirmed the presence of a slightly hypervascular 11-mm solid nodule of the tail of the pancreas, with no other relevant findings (Figure 2). A diagnosis of pancreatic insulinoma was made, and the patient was transferred to the surgery unit for surgical treatment. Informed consent was obtained from the patient, then a robotic distal pancreatectomy with partial omentectomy and splenectomy was performed (Ethics Committee approval was not required in this case, since robotic surgery falls within common clinical practice in Italy for this indication).

Bottom Line: Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor.Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences.Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.

View Article: PubMed Central - PubMed

Affiliation: From the Unit of Digestive and Liver Surgery (AP, JD, VG, ST, AC), Santa Maria Hospital, Terni; Department of General and Oncologic Surgery (RC, FB, AC, CR, GN), University of Perugia, Perugia; Unit of Internal Medicine (FA, FB, GP, GS), Santa Maria Hospital, Terni; and Department of Medicine (FA, FB, GP, GS), University of Perugia, Perugia, Italy.

ABSTRACT
Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of loss of consciousness in a patient with pancreatic insulinoma. In the previous months, the patient had occasionally reported nonspecific symptoms. During hospitalization, endocrine examinations were compatible with an insulin-producing tumor. Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor. The patient underwent a robotic distal pancreatectomy with partial omentectomy and splenectomy. Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences. Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.

Show MeSH
Related in: MedlinePlus