title: Arterial stimulation and venous sampling (ASVS) is useful for recurrent lesions of insulinoma: a case report.
abstract: We encountered a recurrent case of benign solitary insulinoma in the pancreatic tail, which may have been caused by an inadequate surgical margin in the use of an ultrasonic dissector. A 45-year-old man was referred with hypoglycemia and diagnosed solitary insulinoma in the pancreas. Laparoscopic pancreatic enucleation was performed using an ultrasonic dissector. The tumor was extracted and the surgical margins were microscopically negative. Six years later, he presented with hypoglycemia again. Multiple small well-enhanced lesions were detected by computed tomography distant from the resection stump of the first operation. He underwent resection of all visible lesions with omentum and wide excision of the soft tissue surrounding the pancreas after preoperative arterial stimulation and venous sampling test. The postoperative course of the second operation was uncomplicated and the patient presents no sign of hypoglycemia after 12 months.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Kutsuna
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Itoh
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Atsuko
authors.initials: A
authors.lastname: Iwama
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Yoshikura
authors.initials: Y
authors.lastname: Haraguchi
authors.forename: Toshisada
authors.initials: T
authors.lastname: Ueda
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
mesh_terms: D002125:Calcium Gluconate / Q000008:administration & dosage*; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000097:blood*; D007340:Insulinoma / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D014464:Ultrasonic Therapy / Q000295:instrumentation
chemical_list: D005765:Gastrointestinal Agents; D007328:Insulin; D002125:Calcium Gluconate