Zollinger–Ellison syndrome caused by solitary gastrinoma blocking the pancreatic duct: Enucleation and pancreatic duct repair

      A 25-year-old woman presented in 1987 with persistent diarrhea (up to 30 bowel movements per day). She had a 5-year history of dyspepsia, 1 episode of hematemesis secondary to duodenitis, and a prior emergent cecectomy for a perforated cecal ulcer of questionable etiology. Fasting serum gastrin was 383 pg/mL (normal, <90 pg/mL), secretin-stimulated serum gastrin was 1200 pg/mL (normal rise, <200 pg/mL), basal acid output was 32 mEq/h (normal, 2-3 mEq/h), and peak acid output was 69 mEq/h (normal, 10-15 mEq/h), all establishing the diagnosis of Zollinger–Ellison syndrome. Computed tomography revealed a dilated pancreatic duct without evidence of a gastrinoma in the pancreas or liver. Directed ultrasound, however, identified a nodule in the head of the pancreas obstructing the pancreatic duct. Endoscopic retrograde pancreatography confirmed partial blockage of the main pancreatic duct (Fig 1). Further history and biochemical evaluation ruled out multiple endocrine neoplasia I.
      Figure thumbnail gr1
      Fig 1Endoscopic retrograde pancreatography.
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