title: The Selective Arterial Calcium Injection Test is a Valid Diagnostic Method for Invisible Gastrinoma with Duodenal Ulcer Stenosis: A Case Report.
abstract: The localization and diagnosis of microgastrinomas in a patient with multiple endocrine neoplasia type 1 is difficult preoperatively. The selective arterial calcium injection (SACI) test is a valid diagnostic method for the preoperative diagnosis of these invisible microgastrinomas. We report a rare case of multiple invisible duodenal microgastrinomas with severe duodenal stenosis diagnosed preoperatively by using the SACI test. A 50-year-old man was admitted to our hospital with recurrent duodenal ulcers. His serum gastrin level was elevated to 730 pg/ml. It was impossible for gastrointestinal endoscopy to pass through to visualize the inferior part of the duodenum, because recurrent duodenal ulcers had resulted in severe duodenal stenosis. The duodenal stenosis also prevented additional endoscopic examinations such as endoscopic ultrasonography. Computed tomography did not show any tumors in the duodenum and pancreas. The SACI test provided the evidence for a gastrinoma in the vascular territory of the inferior pancreatic-duodenal artery. We diagnosed a gastrinoma in the peri- ampullary lesion, so we performed Subtotal Stomach-Preserving Pancreatico- duodenectomy with regional lymphadenectomy. Histopathological findings showed multiple duodenal gastrinomas with lymph node metastasis and nonfunctioning pancreatic neuroendocrine tumors. Twenty months after surgery, the patient is alive with no evidence of recurrence and a normal gastrin level. In conclusion, the SACI test can enhance the accuracy of preoperative localization and diagnosis of invisible microgastrinomas, especially in the setting of severe duodenal stenosis.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Okada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sudo
authors.forename: Katsunari
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakashita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Hironori
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Otsuka
authors.forename: Takuya
authors.initials: T
authors.lastname: Sakoda
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
mesh_terms: D002118:Calcium / Q000008:administration & dosage*; D003251:Constriction, Pathologic / Q000209:etiology; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004381:Duodenal Ulcer / Q000150:complications*; D015408:Gastrinoma / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007269:Injections, Intra-Arterial; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged
chemical_list: D002118:Calcium