Introduction: Insulinoma is a rare neuroendocrine tumour of the pancreas presenting with hypoglycemia and associated symptoms. Laparoscopic excision is the standard of care. We present a case of an insulinoma who developed recurrent pancreatitis following enucleation and hence required ERCP and pancreatic duct stenting.
Case Report: We report a case of a 42-year-old female patient with complaints of frequent episodes of hypoglycemia, headache and jerky movement of all 4 limbs on and off past 2 years. She also had associated headache, fatigue and seizure-like activity. The last seizure episode was 2 days before admission. These symptoms were affecting her day-to-day activities. On one local visit, the patient was tested blood sugar level and showed < 50g/dL and on similar visits it turned out to be low and suspicion of intra-abdominal pathology. She underwent CECT abdomen, which showed suspicion of insulinoma and was referred to our institution for further management.
Management: Patient took Exendin uptake Scan(PET), MRI and confirming the diagnosis of insulinoma and no communicating ductal abnormality of pancreatic duct. Patient was planned for laparoscopic enucleation of nodular 2x2cm insulinoma head of pancreas. Post-operatively patient’s sugar levels improved. After the specimen histopathology confirmed the same diagnosis, the patient was discharged. After 3 months of an asymptomatic period, she developed recurrent attacks of acute pancreatitis. The initial 2 attacks of pancreatitis were mild, and the patient improved on conservative management. Of the total 3 attacks of acute pancreatitis in 1 month, the last episode was severe, and the patient was not responding to IV medications. MRCP showed peri-pancreatic fluid collection at the head of the pancreas corresponding to the previous lesion. As a post-op complication patient developed pancreatitis with fluid collection. With ERCP and pancreatic duct stenting, fluid collection was drained and successfully managed.
Conclusion: We report a rare case of an Insulinoma head of the pancreas which was diagnosed incidentally. With the evolution of minimally invasive techniques, the patient was successfully managed by Laparoscopic enucleation of insulinoma and Endoscopic retrograde cholangiopancreatography (ERCP)+ pancreatic stenting.
Keywords: Neuroendocrine tumor (NET), Insulinoma, Exendin uptake scan (PET), Enucleation, Endoscopic retrograde cholangiopancreatography (ERCP), Postoperative pancreatitis, Peripancreatic fluid collection.
Citation:Easwaramoorthy, S. et al., (2025). Hurdles and Challenges during Laparoscopic Enucleation of Insulinoma Head of Pancreas – An Interesting Case Report. J Sur & Surgic Proce.,3(4):1-5.
DOI : https://doi.org/10.47485/3069-8154.1022