Percutaneous transhepatic pancreatic vein catheterization in localization of insulinoma

Localization of pancreatic insulinomas can present considerable operative difficulty. Blind pancreatic resections are likely to miss the tumor and are associated with the concomitant morbidity and mortality of repeated explorations and resections. While arteriography is often very helpful in locating the tumor preoperatively, there are some patients in whom a tumor blush cannot be seen. The use of percutaneous transhepatic pancreatic vein sampling for radioimmune insulin assay is reviewed, with particular emphasis on its usefulness in locating a small insulinoma. The technique is readily adaptable to other endocrine-secreting tumors of the pancreas.