Abstract
We report a case of a 67-year-old male patient
with an insulinoma of pancreas at the junction
of body and tail. He underwent a laparoscopic
spleen preserving distal pancreatectomy. Patient
presented with episodes of giddiness and
drowsiness for past 4 months. There was also
history of tremor on exertion since 4 months.
His symptoms improved with intake of food.
During his episodes his blood sugar levels
ranging from 35 mg% – to 50 mg%. Patient was
thoroughly evaluated. USG abdomen and MRI
abdomen showed normal study. His fasting
serum insulin level raised with normal ACTH
and cortisol level. DOTA PET Scan suggestive
of focal octreotide receptor expressing lesion at
the junction of body and tail of pancreas. There
were no postoperative complications, and the
patient was discharged from the hospital on day
- The patient was ambulatory soon after the
procedure. He was allowed to take oral liquids
after 12 hrs post surgery, and his hospital stay
was short; therefore, the surgery was judged to
have been highly useful.
Introduction
Insulinoma is the most common neuroendocrine
tumor of the pancreas. Peak incidence of
occurrence is between 40 to 69 years. About
40% – 90 % of tumors are nonfunctional.
Rest of them manifest with evident hormonal
symptoms. Of the functional tumors 70% are
insulinoma, of which 90% are benign. Usually
present with symptoms like anxiety, confusion,
dizziness, headaches, and sweating. Treatment
for insulinoma is surgical excision, however
before surgery; symptoms of excess hormones
must be corrected. Patients with neuroendocrine
tumor after surgery generally do well for years.
Distal pancreatectomy (DP) is the removal
of the pancreatic tissue at the left side of the
superior mesenteric vein and it is traditionally
approached by an open or laparoscopic exposure.
Preservation of the spleen is optional but appears
to have a better immunological outcome.