scholarly journals A Perplexing Case of Abdominal Pain That Led to the Diagnosis of Zollinger-Ellison Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Adrienne Lenhart ◽  
Mona Hassan ◽  
Alireza Meighani ◽  
Omar Sadiq ◽  
Yousuf Siddiqui
Keyword(s):  
Abdominal Pain ◽  
Somatostatin Receptor ◽  
Duodenal Bulb ◽  
Gastrin Level ◽  
Multiple Modalities ◽  
Clinical Disorder ◽  
Delay In Diagnosis ◽  
Zollinger Ellison Syndrome ◽  
Receptor Scintigraphy ◽  
Gi Symptoms

Zollinger-Ellison syndrome (ZES) is a rare clinical disorder, characterized by hypersecretion of gastric acid and multiple ulcers distal to the duodenal bulb. This occurs via the release of gastrin by neuroendocrine tumors known as gastrinomas. Patients with ZES present with nonspecific GI symptoms, which often leads to a delay in diagnosis. Our patient is a 55-year-old female with chronic abdominal pain, nausea, and diarrhea. She underwent EGD, EUS, MRCP, CT scans, and cholecystectomy, which did not reveal the cause of her symptoms. Repeat EGD showed a cratered ulcer in the second portion of the duodenum, suspicious for ZES. Serum gastrin was initially only moderately elevated while on PPI therapy, but chromogranin A was also elevated. Repeat gastrin level after stopping PPI therapy was 1639 pg/mL. Somatostatin receptor scintigraphy was obtained, which showed two small lesions in the gastrinoma triangle. She subsequently underwent a Whipple pancreaticoduodenectomy and pathology was positive for four microscopic foci of a neuroendocrine tumor. She reported improvement in her symptoms after surgery. This case highlights the need for increased awareness of ZES in patients with unexplained GI complaints and emphasizes the use of multiple modalities in the diagnosis of ZES.

scholarly journals Prospective Study of Somatostatin Receptor Scintigraphy and its Effect on Operative Outcome in Patients With Zollinger-Ellison Syndrome

1998 ◽  
Vol 228 (2) ◽  
pp. 228-238 ◽  
Author(s):  
H. Richard Alexander ◽  
Douglas L. Fraker ◽  
Jeffrey A. Norton ◽  
David L. Bartlett ◽  
Lok Tio ◽  
...  
Keyword(s):  
Prospective Study ◽  
Somatostatin Receptor ◽  
Somatostatin Receptor Scintigraphy ◽  
Zollinger Ellison Syndrome ◽  
Receptor Scintigraphy ◽  
Operative Outcome

scholarly journals Primary hepatic gastrinoma being diagnosed preoperatively: a case report and literature review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunya Hanzawa ◽  
Hiroshi Sadamori ◽  
Masaaki Kagoura ◽  
Kazuteru Monden ◽  
Masayoshi Hioki ◽  
...  
Keyword(s):  
Serum Gastrin ◽  
Somatostatin Receptor ◽  
Gastrin Level ◽  
Serum Gastrin Level ◽  
Cystic Degeneration ◽  
Hepatic Lobectomy ◽  
Zollinger Ellison Syndrome ◽  
Right Hepatic Lobectomy ◽  
Serum Gastrin Concentration ◽  
Primary Hepatic Gastrinoma

Abstract Background A majority of gastrinomas causing Zollinger–Ellison syndrome are located in the duodenum or pancreas. Primary hepatic gastrinomas are rare and difficult to diagnose. We report a rare case of primary hepatic gastrinoma, which could be diagnosed preoperatively. Case presentation A 29-year-old man with a 55-mm tumor in segments 5 and 6 (S 5/6) of the liver was admitted to our hospital. After thorough investigations, he was treated for a suspected inflammatory pseudotumor and advised to undergo routine follow-up. Two years later, he revisited our hospital with a complaint of abdominal pain, vomiting, and diarrhea. Upper gastrointestinal endoscopy revealed multiple duodenal ulcers. His serum gastrin level was 2350 pg/mL (normal: 37–172 pg/mL), suggesting Zollinger–Ellison syndrome. Abdominal computed tomography showed a 78-mm hypervascular tumor with cystic degeneration in the S 5/6 region of the liver, with a potential to increase over time. The tumor showed hypointensity on T2-weighted and hyperintensity on diffusion-weighted abdominal contrast-enhanced magnetic resonance imaging. Somatostatin receptor scintigraphy (SRS) only detected a hepatic tumor. No tumors in the gastrinoma triangle were detected by endoscopic ultrasonography. Hence, selective arterial calcium injection (SACI) test was performed to determine the location of the gastrinoma. The serum gastrin concentration increased from 4620 pg/mL to 23,600 pg/mL at 20 s after calcium gluconate injection into the proper hepatic artery. Conversely, no effect on serum gastrin level was observed after the injection into any other arteries. Extended right hepatic lobectomy and cholecystectomy were performed after percutaneous transhepatic portal vein embolization. A histopathological examination of the liver tumor revealed a gastrinoma. The patient’s serum gastrin concentration on postoperative day 1 decreased to 65 pg/mL. Conclusion We report a surgical case of primary hepatic gastrinoma correctly diagnosed preoperatively. The patient underwent extended right hepatic lobectomy, resulting in a histological definitive diagnosis of primary hepatic gastrinoma.

Somatostatin receptor scintigraphy in forty-eight patients with the Zollinger-Ellison syndrome

1994 ◽  
Vol 21 (11) ◽  
pp. 1191-1197 ◽  
Author(s):  
Eric de Kerviler ◽  
◽  
Guillaume Cadiot ◽  
Rachida Lebtahi ◽  
Marc Faraggi ◽  
...  
Keyword(s):  
Somatostatin Receptor ◽  
Somatostatin Receptor Scintigraphy ◽  
Zollinger Ellison Syndrome ◽  
Receptor Scintigraphy

scholarly journals Five-Year Long-Term Followup of a Primary Lymph node Gastrinoma: Is a Pancreaticoduodenectomy Justified?

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Bernd Jaenigen ◽  
Gian Kayser ◽  
Berthold Steinke ◽  
Oliver Thomusch
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Somatostatin Receptor ◽  
Gastrin Level ◽  
Receptor Scintigraphy ◽  
Biochemical Cure ◽  
Primary Lymph Node ◽  
Partial Pancreatoduodenectomy ◽  
Typical Localization

Background. Gastrinoma-positive lymph nodes and failed localization of the primary tumor during surgical exploration are described. Specialists suppose that these lymph nodes are metastases rather than a primary gastrinoma.Methods. Case report with a five-year long-term followup. A 60-year-old patient with an confirmed gastrinoma was treated in our department. All preoperative evaluations including somatostatin-receptor-scintigraphy and F-Dopa PET failed to localize the gastrinoma. Explorative laparotomy revealed a gastrinoma in two peripancreatic lymph nodes. Despite extensive intraoperative exploration, no primary gastrinoma could be detected in typical localization.Results. Over a period of 5 years, the patient's gastrin level stayed in the normal range and the patient seems to be completely cured.Conclusion. A prophylactic partial pancreatoduodenectomy is not indicated to avoid recurrence, since complete biochemical cure by local resection of the lymph node gastrinoma is possible.

Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Peter Wang
Keyword(s):  
Abdominal Pain ◽  
Digestive Enzymes ◽  
Gallbladder Disease ◽  
Hepatobiliary Scintigraphy ◽  
Hepatobiliary Imaging ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Abdominal ◽  
Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

scholarly journals Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

2018 ◽  
Vol 73 (Suppl. 4) ◽  
pp. 39-46 ◽  
Author(s):  
Frank M. Ruemmele
Keyword(s):  
Abdominal Pain ◽  
Celiac Disease ◽  
Clinical Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Clear Cut ◽  
Clinical Presentations ◽  
New Findings ◽  
Three Phase ◽  
Gi Symptoms

Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1–10% in the general population and to increase steadily; however, most data are based on patients’ self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.

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