Inevitable emergency pancreaticoduodenectomy in patient with Gastrinoma.

Abstract

Gastrinoma is a rare endocrine tumor with clinical triads of atypical virulent peptic ulcer diathesis, massive gastric acid hypersecretion, and non-β islet cell pancreatic tumors that produce
excessive gastrin hormone. Ulceration in stomach or duodenum are mostly uncommon in location,multiple and intractable, and recur after surgery for peptic ulcer treatment Report of a male patient with upper gastrointestinal hemorrhage which occurred from multiple second part duodenal ulcers. Standard medical treatment with both proton pump inhibitor and long-acting somatostatin analog were administered. Intractable massive duodenal hemorrhage was subsequently determined with prolong hypotension and life-threatening, the patient then underwent emergency pancreaticoduodenectomy. Histopathology was compatible with gastrinoma.

More than two years follow up, there was no evidence of gastrointestinal hemorrhage after surgical treatment, and only a small stomal ulcer was found endoscopically and was easily cured with
standard medical treatment. Still no residual primary or metastatic tumors was localized by special investigation. The result of such surgical treatment may reflect the successive procedure to remove
the affective tumor from çgastrinoma triangleé. Only two reports of surgical treament in gastrinoma patients in Thailand were published, but there was no report of pancreaticoduodenectomy. But
Pancreaticoduodenectomy was done in other parts of the world.