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Abstract: Islet cell tumor is a common endocrine tumor of the pancreas, often with recurrent hypoglycemia as the main manifestation. The patient in this case was a 65-year-old grandfather who visited the clinic for recurrent unconsciousness, and sometimes the symptoms could be relieved by eating something. An intensive CT examination of the abdomen was performed to suggest islet cell tumor in the head of the pancreas, and the patient was given islet cell tumor resection under general anesthesia, after which the patient’s hypoglycemic symptoms gradually improved and his blood glucose gradually returned to normal, with good treatment results.
Basic information】Male, 65 years old
Disease Type】Isloblastoma of the pancreas
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (islet cell tumor resection)
Treatment Period】2 weeks of hospitalization
Effectiveness of treatment】The symptoms of hypoglycemia disappeared, blood glucose level recovered, and the treatment effect was good
I. Initial consultation
The patient complained of sudden unconsciousness or fainting in the morning since more than 1 year, sometimes he could recover by himself, sometimes he needed to eat something to return to normal, no significant abnormalities were found in the cranial CT examination at the local hospital, and neurological lesions were ruled out. The patient was found to have recurrent hypoglycemia, and an intensive abdominal CT was performed, which revealed a 1.5cm tumor in the head of the pancreas with significant enhancement.
II. Treatment process
Based on the patient’s typical symptoms of recurrent hypoglycemia and the typical imaging performance of abdominal intensive CT, the diagnosis of pancreatic islet cell tumor is clear, and it is an endocrine tumor of the pancreas. The biggest risk of surgery is the possibility of postoperative pancreatic fistula, and the patient’s family agreed to the surgical treatment, and the patient was given islet cell tumor resection under general anesthesia. The patient did develop a pancreatic fistula on the 5th postoperative day, but due to accurate preoperative evaluation and precise intraoperative operation, the patient’s pancreatic fistula drained very well through the abdominal drainage tube and did not cause abdominal fluid accumulation or abdominal infection, and the patient recovered after 2 weeks of hospitalization and was discharged with a drainage tube.
III. Treatment effect
After the operation, the patient’s blood sugar level gradually returned to normal, and no more hypoglycemia occurred. On the 3rd postoperative day, the patient could get out of bed and started to eat after the appearance of defecation. On the 5th postoperative day, a pancreatic fistula appeared, but it was drained very well through the abdominal drainage tube, and there was no accumulation of fluid in the abdominal cavity or abdominal infection. On about the 10th postoperative day (2 weeks of hospitalization), normal diet and activities resumed, but the amount of pancreatic fistula was 50mL per day, so the patient was advised to be discharged with a tube to keep the abdominal drainage tube draining freely and to be reviewed regularly. In conclusion, after treatment, the patient’s hypoglycemic symptoms disappeared, blood glucose level recovered, and the treatment effect was good.
IV. Notes
We are glad that after treatment the patient’s hypoglycemia symptoms disappeared and blood sugar level recovered symptoms. In terms of diet, pay attention to a light diet, avoid spicy and stimulating food, increase nutrition, eat more lean meat, milk, fish, shrimp and other high-protein substances, and also eat more fresh fruits and vegetables to supplement sufficient vitamins. If the amount of drainage suddenly decreases or symptoms such as abdominal pain and fever appear, the patient should return to the hospital for review in time. At the same time, the blood sugar level should be monitored to prevent tumor recurrence.
V. Personal insight
Islet cell tumor is a common endocrine tumor of the pancreas, the main symptom of which is recurrent hypoglycemia. In this case, the patient came to our hospital because of recurrent hypoglycemia, and the cause was not identified at first. Later, she came to our hospital for further blood glucose check and intensive abdominal CT examination, which led to a clear diagnosis and surgical treatment to remove the tumor. After the surgery, the blood sugar returned to normal and the symptoms of hypoglycemia such as unconsciousness did not appear again.