title: Multi-visceral resection of pancreatic VIPoma in a patient with sinistral portal hypertension.
abstract: BACKGROUND
  VIPomas are rare neuroendocrine tumors poorly described in the literature. Aggressive resection of patients with advanced VIPoma neuroendocrine tumors has rarely been reported.
  
  
  METHODS
  A 46 year old women presented with abdominal pain and diarrhea. A three-dimensional (3-D) pancreas protocol computed tomography scan revealed an 18 x 12 cm pancreatic VIPoma abutting the liver, stomach, spleen, left adrenal, colon that also invaded the distal duodenum - proximal jejunum at the ligament of Treitz in association with sinistral portal hypertension. Following preoperative proximal splenic artery embolization, the patient with underwent successful en bloc resection of the locally advanced VIPoma in conjunction with a diaphragmatic resection, total gastrectomy, splenectomy, left adrenalectomy, as well as small and large bowel resection. The estimated blood loss was 500 ml. All margins were negative (R0 resection). The patient is alive and disease-free.
  
  
  CONCLUSIONS
  This case illustrates the role of aggressive resection of pancreatic neuroendocrine tumors and highlights several key technical points that allowed for successful resection.
authors.affiliation: Departments of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 22187-6681, USA. djoyce4@gmail.com
authors.forename: David L
authors.initials: DL
authors.lastname: Joyce
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Joshua
authors.initials: J
authors.lastname: Wisell
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000315:Adrenalectomy; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D003969:Vipoma / Q000473:pathology / Q000601:surgery*