George N Zografos Third Department of Surgery Athens General Hospital, Greece EAES CONGRESS, GENEVA 2013

1. George N Zografos
Third Department of Surgery
Athens General Hospital, Greece
EAES CONGRESS, GENEVA 2013
Am Surgeon 2010;76(4):1-3

2. 36 y/o female
Admission to the Department of Neurology
Confusion, disorientation, difficulty in waking up in the
morning
Electroencephalographic pathologic findings
CT, MRI brain: no abnormal findings

3.  CT abdomen showed a
14 mm benign tumor in
the tail of pancreas
 MRI abdomen: similar
findings

4.  Somatostatin receptors
scan: normal
111 In-octreotide scan:
normal
Arteriography of the
celiac trunk: normal
findings

5.  Selective intra-arterial stimulation with calcium
glyconate injection and venous sampling:
 Remarkable increase of insulin by stimulation of
the distal DSA

6.  EUS: 12x9 mm
hypoechoic,
homogenous
lesion in the tail of
pancreas (FNA)
 Preoperative EUS
tattooing of the tumor
with 1 ml methylene-
blue

7.  Laparoscopic resection of the insulinoma
 Postoperative pancreatic fistula (10 ml/per day
αμυλάση 826 IU)) for 15 days.
 Discharge from Hospital at the 3rd postop. Day
 Histology: Benign insulinoma