主膵管に近接した膵頭部インスリノーマを核出しえた1例

Abstract

A 76 year-old man had presented consciousness disturbance since about 2000 ; it was diagnosed as transient cerebral ischemic attack or an epilepsy stroke. He was found to have hypoglycemia at the end of 2004 and was admitted to our hospital for a careful examination. Abdominal enhanced CT showed a hypervascular round mass about 15 mm in diameter located in the pancreatic head. An arterial stimulation venous sampling suggested that the tumor was fed by the inferior pancreaticoduodenal artery and the gastroduodenal artery. The tumor was interpreted as consistent with islet cell tumor, so-called insulinoma, in the pancreatic head. He underwent surgical resection at the end of April, 2005. By intraoperative ultrasonography, the tumor was shown to be in the pancreatic head, located near the main pancreatic duct and common bile duct. We used a Cavitron Ultrasonic Surgical Aspirator and could enucleate while confirming the relation of the tumor and the main pancreatic duct in real time by intraoperative ultrasonography.