Dados do Trabalho

Título

Partial pancreatectomy with splenic preservation for neuroendocrine tumour

Apresentação do caso

Female, 63 years old, white. Previously healthy, started 3 years
ago with sporadic mental confusion. In the last year, evolved with almost daily
episodes of dizziness, and episodes of mental confusion became more frequent,
associated with sweating and lowered levels of consciousness, leading to the search
for emergency services, where hypoglycaemia was detected.
The patient began to perceive that the symptoms of malaise and sweating, usually
nocturnal, stopped with the consumption of foods rich in glucose, and the initial tests
showed fasting glucose of 46 mg/dL. Initial investigation with endoscopy revealed
extrinsic bulging of the gastric body wall, indicating diagnostic complementation with
computed tomography that demonstrated the presence of a circumscribed
hypervascular nodule located in the body-caudal transition of the pancreas
measuring 2.0 x 1.6 x 1.7 cm.
Videolaparoscopic partial pancreatectomy with splenic preservation was performed.
Dissection of the vascular structures of the spleen was performed through the
posterior surface of the pancreas, allowing the parenchyma to be sectioned using an
endoscopic linear stapler.
Postoperative recovery was satisfactory, with disappearance of neuroglycopenic
symptoms and normalization of glucose levels. Histopathological and
immunohistochemical analyses were compatible with a well-differentiated
neuroendocrine tumour.

Discussão

Insulinoma has an incidence of 1/1 million inhabitants/year. It is a
neoplasm of pancreatic beta cells that increase insulin production. It is characterized
by Whipple’s triad: low blood glucose levels (40-50 mg/dL), fasting-induced
neuroglycopenic symptoms, and relief of symptoms after glucose administration.
Surgery is the standard and curative treatment, and videolaparoscopy is the method
of choice because it is associated with shorter postoperative recovery time and lower
morbidity. The splenic preservation must always be considered due to the organ’s
immune function, especially against encapsulated microorganisms and the
knowledge that splenectomized patients have increased septic morbidity and
mortality.

Comentários Finais

The rarity of the event does not exclude the importance of clinical
suspicion regarding hypoglycaemia – common in clinical practice, especially when
associated with other neuroglycopenic symptoms. Additionally, it emphasizes the
importance of choosing the surgical technique used to ensure therapeutic success
and reduced morbidity and mortality.

Palavras Chave

Insulinoma, hypoglycaemia, neuroendocrine tumour.