scholarly journals Case Report: A Difficult-to-Diagnose Case of Hyperinsulinemic Hypoglycemia Surgically Treated After Developing Acute Pancreatitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chisa Inoue ◽  
Kota Nishihama ◽  
Aoi Hayasaki ◽  
Yuko Okano ◽  
Akinobu Hayashi ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Islets Of Langerhans ◽  
Developmental Disorders ◽  
Pancreatic Tumor ◽  
Tube Feeding ◽  
Neuroendocrine Cells ◽  
Hyperinsulinemic Hypoglycemia ◽  
Histopathological Study ◽  
Old Japanese ◽  
Clinical Records

The patient is a 28-year-old Japanese man diagnosed with severe congenital hyperinsulinemic-hypoglycemia six months after birth. Clinical records revealed no imaging evidence of pancreatic tumor at the time of diagnosis. Subsequently, he had developmental disorders and epilepsy caused by recurrent hypoglycemic attacks. The patient’s hypoglycemia improved with oral diazoxide. However, he developed necrotizing acute pancreatitis at 28 years of age, thought to be due to diazoxide. Discontinuation of diazoxide caused persistent hypoglycemia, requiring continuous glucose supplementation by tube feeding and total parenteral nutrition. A selective arterial secretagogue injection test revealed diffuse pancreatic hypersecretion of insulin. He underwent subtotal distal (72%) pancreatectomy and splenectomy. There was no intraoperative visible pancreatic tumor. His hypoglycemia improved after the surgical procedure. The histopathological study revealed a high density of islets of Langerhans in the pancreatic body and tail. There were large islets of Langerhans and multiple neuroendocrine cell nests in the whole pancreas. Nests of neuroendocrine cells were also detected in lymph nodes. The pathological diagnosis was grade 1 neuroendocrine tumor (microinsulinomas) with lymph node metastases. This patient is a difficult-to-diagnose case of hyperinsulinemic hypoglycemia surgically treated after developing acute pancreatitis. We believe this is a unique case of microinsulinomas with lymph metastases diagnosed and treated as congenital hyperinsulinemic hypoglycemia for almost 28 years.

scholarly journals Pancreatic Follicular Lymphoma Presenting as Acute Pancreatitis: Report of a Case

2015 ◽  
Vol 100 (6) ◽  
pp. 1078-1083 ◽  
Author(s):  
Yoshihiro Shirai ◽  
Tomoyoshi Okamoto ◽  
Masaru Kanehira ◽  
Shinji Onda ◽  
Fumitake Suzuki ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Differential Diagnosis ◽  
Follicular Lymphoma ◽  
B Cell ◽  
Pancreatic Tumor ◽  
Cell Lymphoma ◽  
Magnetic Resonance Cholangiopancreatography ◽  
B Cell Lymphoma ◽  
The Body ◽  
Pancreatic Lymphoma

Pancreatic B-cell lymphoma is rare; it accounts for 0.2% to 2.0% of extranodal non-Hodgkin lymphoma, and constitutes less than 0.5% of all pancreatic malignancies. Most histologic types of the pancreatic lymphoma are diffuse large B-cell lymphoma, and follicular lymphoma is quite rare. We report here a case of pancreatic follicular lymphoma that was initially detected by acute pancreatitis. This is the first reported case of pancreatic follicular lymphoma presenting with acute pancreatitis. A 71-year-old woman had epigastric and left upper quadrant abdominal pain. Computed tomography (CT) revealed features of acute pancreatitis. After standard therapy for pancreatitis, enhanced CT showed a pancreatic tumor (50 × 35 mm) in the body of the pancreas with gradual enhancement. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed a complete interruption of the pancreatic duct in the body, with mild dilation of the duct in the tail of the pancreas. Endoscopic ultrasonography revealed hypervascularity of the pancreatic tumor. The patient underwent distal pancreatectomy to remove the cause of pancreatitis and to disclose the diagnosis. Histologic examination revealed follicular lymphoma of pancreas. Despite recent improvement in clinical strategies, differential diagnosis between pancreatic lymphoma and pancreatic cancer is still difficult without histologic information. Pancreatic lymphoma should be considered as a differential diagnosis in a patient who initially presents with acute pancreatitis.

Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

2018 ◽  
pp. 204-208
Author(s):  
Peter J. Fagenholz
Keyword(s):  
Acute Pancreatitis ◽  
Tube Feeding ◽  
Oral Intake ◽  
Adequate Nutrition ◽  
On Demand ◽  
Major Complications ◽  
Nasojejunal Tube ◽  
Poor Oral Intake ◽  
Oral Diet

This study evaluated whether starting nasojejunal tube feeding within 24 hours of presentation would reduce the rate of death or major complications in patients with acute pancreatitis. This strategy was compared to allowing patients to take an “on demand” oral diet and only initiating nasojejunal tube feeding if there was poor oral intake by 96 hours after presentation. There was no difference between the two groups in any of the measured outcomes, though the study may have been underpowered. We conclude it is acceptable to allow an on-demand oral diet and reserve nasoenteric feeding for patients who have not achieved adequate nutrition by 96 hours after presentation. It is not necessary or beneficial to start nasojejunal tube feeds in the first 24 hours.

scholarly journals Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

2014 ◽  
Vol 371 (21) ◽  
pp. 1983-1993 ◽  
Author(s):  
Olaf J. Bakker ◽  
Sandra van Brunschot ◽  
Hjalmar C. van Santvoort ◽  
Marc G. Besselink ◽  
Thomas L. Bollen ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Tube Feeding ◽  
On Demand

Early nasojejunal tube feeding versus nil-by-mouth in acute pancreatitis: A randomized clinical trial

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. 523-528 ◽  
Author(s):  
D. Stimac ◽  
G. Poropat ◽  
G. Hauser ◽  
V. Licul ◽  
N. Franjic ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Acute Pancreatitis ◽  
Randomized Clinical Trial ◽  
Tube Feeding ◽  
Nasojejunal Tube

scholarly journals Management of Refractory Noninsulinoma Pancreatogenous Hypoglycemia Syndrome with Gastric Bypass Reversal: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Bhavana B. Rao ◽  
Benjamin Click ◽  
George Eid ◽  
Ronald A. Codario
Keyword(s):  
Gastric Bypass ◽  
Case Report ◽  
Tube Feeding ◽  
Insulin Level ◽  
Hypoglycemic Agents ◽  
Hyperinsulinemic Hypoglycemia ◽  
Oral Hypoglycemic Agents ◽  
Calcium Stimulation ◽  
History Of ◽  
Maximal Medical Therapy

Background. Roux-en-Y gastric bypass (RYGB) is a commonly performed, effective bariatric procedure; however, rarely, complications such as postprandial hypoglycemia due to noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) may ensue. Management of refractory NIPHS is challenging. We report a case that was successfully treated with RYGB reversal.Case Report. A 58-year-old male with history of RYGB nine months earlier for morbid obesity presented for evaluation of postprandial, hypoglycemic seizures. Testing for insulin level, insulin antibodies, oral hypoglycemic agents, pituitary axis hormone levels, and cortisol stimulation was unrevealing. Computed tomography (CT) scan of the abdomen was unremarkable. A 72-hour fast was completed without hypoglycemia. Mixed meal testing demonstrated endogenous hyperinsulinemic hypoglycemia (EHH) and selective arterial calcium stimulation testing (SACST) was positive. Strict dietary modifications, maximal medical therapy, gastrostomy tube feeding, and stomal reduction failed to alleviate symptoms. Ultimately, he underwent laparoscopic reversal of RYGB. Now, 9 months after reversal, he has markedly reduced hypoglycemia burden.Discussion. Hyperfunctioning islets secondary to exaggerated incretin response and altered intestinal nutrient delivery are hypothesized to be causative in NIPHS. For refractory cases, there is increasing skepticism about the safety and efficacy of pancreatic resection. RYGB reversal may be successful.

ENTERAL TUBE FEEDING IN ACUTE PANCREATITIS AND ITS COMPLICATIONS

2021 ◽  
Vol 17 (78) ◽  
pp. 75
Author(s):  
I. V. Kolosovych ◽  
I. V. Hanol ◽  
I. V. Cherepenko
Keyword(s):  
Acute Pancreatitis ◽  
Tube Feeding ◽  
Enteral Tube Feeding

Pancreas

2020 ◽  
pp. 167-184
Author(s):  
Jad M. Abdelsattar ◽  
Moustafa M. El Khatib ◽  
T. K. Pandian ◽  
Samuel J. Allen ◽  
David R. Farley
Keyword(s):  
Pancreatic Cancer ◽  
Acute Pancreatitis ◽  
Contrast Agent ◽  
Islets Of Langerhans ◽  
Renal Vein ◽  
Pancreatic Surgery ◽  
Left Renal Vein ◽  
Endocrine Function ◽  
Head Of The Pancreas ◽  
Trauma Ct

The pancreas forms from the dorsal and ventral endodermal buds, which develop at the foregut-midgut junction. The head of the pancreas lies in the duodenal C-loop, anterior to the IVC and left renal vein. Islets of Langerhans carry out the endocrine function of the pancreas. Acute pancreatitis is caused by gallstones, alcohol, and trauma. CT with an IV contrast agent may be used to diagnose pancreatitis, pancreatic cancer, or complications after pancreatic surgery. Most patients with acute pancreatitis are managed conservatively. Pancreatic leaks occur in approximately 20% of operations on the pancreas.

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