[Case of Zollinger-Ellison syndrome diagnosed three years after ulcer perforation in the third portion of the duodenum].
A 61-year-old woman was referred to our hospital for a double balloon endoscopy (DBE) examination of small intestine. She had undergone laparotomy for a perforated ulcer of the 3rd portion in the duodenum 3 years prior to this admission. Esophagogastroduodenoscopy at the previous hospital revealed multiple ulcers in the 2nd and 3rd portions in the duodenum. DBE revealed multiple ulcer scars in the proximal jejunum. Zollinger-Ellison syndrome was suspected from the distribution of the ulcers and scars. Serum gastrin was high and a selective arterial calcium injection test showed a step up of gastrin level only in the gastroduodenal artery area. We diagnosed a gastrinoma located on the ventral side of the 2nd portion of the duodenum from imaging studies. The tumor was extirpated and histologically found to be a neuroendocrine tumor in a lymph node. Serum gastrin level decreased to the normal range a day after surgery.
Itaba
Soichi
S
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University.
Honda
Kuniomi
K
Nakamura
Kazuhiko
K
Yoshinaga
Shigetaka
S
Higuchi
Naomi
N
Akiho
Hirotada
H
Gibo
Jyunya
J
Arita
Yoshiyuki
Y
Ito
Tetsuhide
T
Tanaka
Masao
M
Segawa
Yumiko
Y
Iwasa
Tsutomu
T
Takayanagi
Ryoichi
R
D014408:Biomarkers, Tumor / Q000097:blood; D003952:Diagnostic Imaging; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005755:Gastrins / Q000097:blood; D006801:Humans; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D015043:Zollinger-Ellison Syndrome / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
D014408:Biomarkers, Tumor; D005755:Gastrins