Intraoperative localization and confirmation of complete resection of the hypersecreting tissue are the 2 main challenges in the management of pancreatogenous
hypoglycemia. Here, we report our experience with intraoperative portal vein
insulin assay combined with occlusion of the pancreas in the management of pancreatogenous
hypoglycemia. Clinical courses of 2 patients with biochemical evidence of a pancreatogenous
hypoglycemia were studied. The preoperative diagnosis was
multiple endocrine neoplasia 1 (MEN-1) and
nesidioblastosis, respectively. Rapid intraoperative portal vein
insulin assay combined with occlusion of the pancreas was used to localize and confirm complete excision of the hypersecreting tissue.
Hypoglycemia was successfully treated in both the patients. In the MEN-1 patient, 2 small
tumors in the head of pancreas were not resected, as they were deemed noninsulin secreting by intraoperative portal vein
insulin assay, thus avoiding a total
pancreatectomy. In the patient with
nesidioblastosis, using intraoperative portal vein
insulin assay combined with occlusion of the pancreas, an appropriate amount of pancreatic tissue was resected thereby avoiding recurrence and diabetes. This technique may be of particular value in patients with complex conditions such as MEN-1 and
nesidioblastosis, to localize and achieve complete resection of hypersecreting pancreatic tissue.