Removal of mesenteric gastrinoma: a case report

Area of Science:

• Gastroenterology
• Endocrinology
• Surgical Oncology

Background:

• The case involves a 37-year-old male with a history of parathyroid adenoma removal and emergency distal gastrectomy due to duodenal ulcer bleeding.
• Post-gastrectomy, the patient developed stomal ulcers and hypergastrinemia, initially without a detectable gastrinoma.
• A subsequent total gastrectomy was performed, maintaining stable but elevated gastrin levels for five years.

Observation:

• A significant, abrupt increase in fasting plasma gastrin levels was observed, rising from a stable range to over 4000 pg/ml and progressively increasing.
• A primary gastrinoma was eventually localized to the jejunal mesentery.
• The patient exhibited a paradoxical response to secretin, indicative of a gastrinoma.

Findings:

• Complete surgical resection of the jejunal mesenteric gastrinoma was achieved.
• Post-operatively, plasma gastrin levels decreased below the assay limit.
• The paradoxical response to secretin resolved after tumor removal.

Implications:

• This case highlights the importance of considering rare tumor locations like the jejunal mesentery in persistent hypergastrinemia.
• Successful surgical management of a primary mesenteric gastrinoma can lead to biochemical and clinical resolution.
• The study underscores the diagnostic utility of secretin stimulation testing in identifying gastrinomas, especially in complex cases.