Surgical treatment of pancreatic cholera: a case report.
After surgical resection for rectosigmoid carcinoma a 63-year-old man had secretory diarrhea causing severe metabolic acidosis, hypokalemia, hypercalcemia and dehydration. Subsequent investigations revealed a mass measuring 4 x 5 cm in the uncinate process of the pancreas and an elevated vasoactive intestinal polypeptide concentration. The diarrhea responded to treatment with the somatostatin analogue. Sandostatin, and remained under control during a prolonged preoperative period. The patient underwent a Whipple procedure with immediate lessening of his diarrhea. This report illustrates a classic case of vipoma and demonstrates the need to consider this condition in the differential diagnosis of secretory diarrhea, even in the presence of other gastrointestinal lesions. The effectiveness of somatostatin analogues in stabilizing the diarrhea preoperatively is also well illustrated.
Kirkpatrick
A W
AW
Division of General Surgery, Sunnybrook Health Science Centre, Toronto, Ont.
Hanna
S S
SS
Skinner
B A
BA
D003937:Diagnosis, Differential; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D015282:Octreotide / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012811:Sigmoid Neoplasms / Q000601:surgery; D014660:Vasoactive Intestinal Peptide / Q000097:blood; D003969:Vipoma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
D005765:Gastrointestinal Agents; D014660:Vasoactive Intestinal Peptide; D015282:Octreotide