Metastatic malignant insulinoma: debulking for palliation of symptoms

This unusual case is that of a patient who had recent onset of sudden severe hypoglycemic symptoms. CT scan and arteriography demonstrated a large, widely metastatic tumor of the pancreas involving liver, regional lymph nodes, and the superior mesenteric vein. Tissue diagnosis was obtained by percutaneous needle biopsy of a liver metastasis. The patient had to be maintained on a continuous D10W drip until a successful debulking total pancreatectomy was done. She is currently at home on pancreatic enzyme replacement.