Occult insulinoma in a Meckel’s diverticulum: a case report
Keywords:
Occult insulinoma, Heterotopic pancreas, Neuroglycopenia, Meckel’s diverticulumAbstract
Insulinoma is a deceptive endocrine tumour of the pancreas due to its bizarre and nonspecific symptom complex. It is also difficult to localize preoperatively, especially when present in an ectopic location. A 65 year old woman presented with recurrent episodes of hypoglycaemia. She was erroneously under treatment for psychotic disorder. A suspicion of insulinoma led us to investigate her further. Investigations revealed fasting hypoglycaemia, endogenous hyperinsulinism, and a pancreatic parenchymal lesion. On exploration, an incidental Meckel’s diverticulum with a nodule was also found. Histopathology showed an insulinoma of the Meckel’s diverticulum and a benign non-functioning adenoma in the pancreatic nodule. Surgery eventually resulted in restoration of euglycaemia and complete disappearance of patient's symptoms.
Metrics
References
Allison JW, Johnson JF III, Barr LL, Warner BW, Stevenson RJ. Induction of gastroduodenal prolapse by antral heterotopic pancreas. Pediatr Radiol. 1995;25:50-1.
Bassam Abboud, Joe Boujaoude. Occult sporadic insulinoma: Localization and surgical strategy. J World Gastroenterol. 2008 Feb;14(5):657-65.
Service FJ, McMahom MM. Functioning insülinoma-incidence, recurrence and long term survival of patient: a 60 year study. Mayo Clin Proc. 1991;66(7):771-9.
Justin MM. Cates, Timothy L. Williams, Arief A. Suriawinata. Intraductal papillary mucinous adenoma that arises from pancreatic heterotopia within a Meckel’s diverticulum. Arch Pathol Lab Med. 2005 Mar;129(3):e67-9.
Hoey C. Koh, Blaithin Page, Catherine Black, Ian Brown, Stuart Ballantyne, David J. Galloway. Ectopic pancreatic-type malignancy presenting in a Meckel’s diverticulum: a case report and review of literature. World J Surg Oncol. 2009;7:54.
Mesut Ozkaya, Mehmet F. Yuzbasioglu, Irfan Koruk, Erman Cakal, Mustafa Sahin, Basak Cakal. Preoperative detection of insulinomas: two case reports. Cases J. 2008;1:362.
Ana Cláudia Ferreira Rosa, Márcio Martins Machado, Marcella Stival Lemes, Mariana Caetano Barreto, Rodrigo Alvarenga Nunes, Nestor de Barros, et al. Intraoperative ultrasonographic evaluation of insulinomas: an update. Radiol Bras. 2006. Sep/Oct;39(5):361-5.
Whipple AO, Franz VK. Adenoma of islet cells with hyperinsulinism. Am Surg. 1935;101:1299-335.
John P. Martin, Pamela D. Connor, Kerri Charles, JD, University of Tennessee. Meckel’s diverticulum. Am Fam Physician. 2000 Feb;61(4):1037-42.
John J. Park, Bruce G. Wolff, Matthew K. Tollefson, Erin E. Walsh, Dirk R. Larson. Meckel’s diverticulum. Ann Surg. 2005 Mar;241(3):529-33.
Groebli Y, Bertin D, Morel P. Meckel’s diverticulum in adults: retrospective analysis of 119 cases and historical review. Eur J Surg. 2001 Jul;167(7):518-24.
López Alvarenga JC, Cáceres Agreda N, Rivera L, Gamboa A, Gómez Pérez FJ, Rull JA. Diagnosis of malignant and benign insulinoma. Experience of the National Institute of Nutrition. Rev Invest Clin. 1999 May-Jun;51(3):167-73.
