The strange disease lasted for nine years, and it turned out to be insulinoma that was causing the problem!

Mr. Wang, who is nearly 60 years old, is very fed up because he contracted some strange disease nine years ago. He has repeated sudden loss of consciousness, talking to himself, and sometimes his limbs keep twitching. Sometimes he is in a very low mood. He has been to many hospitals for treatment, but the diagnosis is unclear. He was once treated for epilepsy and depression, but the treatment effect was not good, which seriously affected his quality of life and made his family worried.

The patient's symptoms recurred recently, and he went to the Endocrinology Department of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) for treatment. It was found that the patient's lowest blood sugar was only 1.5mmol/L. The endocrinology team conducted a detailed examination and highly suspected that the culprit was the refractory hypoglycemia caused by insulinoma. They then completed abdominal CT and MRI examinations and found a mass with a diameter of about 2cm at the splenic hilum of the pancreatic tail.

A multidisciplinary discussion was then initiated, with participation from the Department of Endocrinology, Department of Psychiatry, Department of Psychology, Department of General Surgery Minimally Invasive Center, and Department of Gastroenterology. It was unanimously agreed that the patient's symptoms were consistent with the clinical manifestations of insulinoma, that the tumor could be located at the tail of the pancreas, and that surgery was the best treatment option.

After active communication, the patient was transferred to the General Surgery Minimally Invasive Center of Hunan Second People's Hospital (Provincial Brain Hospital) for surgery. Considering the poor location of the tumor, located on the dorsal side of the pancreatic tail, sandwiched between the splenic hilum and the splenic artery and vein, with dense branching vessels, it is easy to cause collateral damage. However, in order to preserve the patient's pancreatic and splenic functions to the maximum extent, with the cooperation of the Department of Anesthesiology and Surgery, the surgical team of Zhou Xiaobing, deputy chief physician of the General Surgery Minimally Invasive Center, and Zeng Hui, attending physician, adopted a total laparoscopic pancreatic tail tumor enucleation to preserve the spleen and pancreas, successfully preserving the spleen and pancreas functions.

The postoperative pathological results confirmed that it was an insulinoma. After the operation, Mr. Wang no longer had hypoglycemia, epilepsy, or depression-like symptoms. With the careful care of the medical team, he recovered and was discharged from the hospital smoothly.

Chen Dandan, deputy chief physician of the Department of Endocrinology, introduced that the early symptoms of insulinoma are hypoglycemia symptoms such as dizziness, palpitations and cold sweats, presenting as the "Whipple triad", including: 1. Spontaneous periodic attacks of hypoglycemia symptoms, coma and its neuropsychiatric symptoms, occurring on an empty stomach or after work; 2. Blood sugar is lower than 2.8mmol/L during an attack; 3. Symptoms can disappear immediately after oral or intravenous injection of glucose.

Therefore, if you frequently experience symptoms such as dizziness, palpitations, and cold sweats on an empty stomach or after work, you should be alert to insulinoma and see a specialist promptly. Do not delay treatment by assuming that you simply have hypoglycemia.

The difficulty in treating insulinoma lies in the preoperative qualitative and accurate positioning. Some insulinomas are multiple and lack the imaging manifestations of conventional pancreatic endocrine tumors. Preoperative CT and MRI cannot accurately characterize and position the lesions, and lesions are easily missed. In addition to conventional CT and MRI examinations, the diagnosis of insulinoma also requires the combination of other diagnostic methods such as endoscopic ultrasound, PET-CT examinations, and intraoperative ultrasound.

Guo Yuanping, chief physician of the Minimally Invasive General Surgery Center, said that surgery is the best option for curing insulinomas. About 90% of insulinomas are benign and can be cured after surgical removal of the tumor. Unlike traditional pancreatic body and tail tumor surgery, pancreatic body and tail tumor resection with preserved splenic blood vessels is difficult. The difficulty of the operation lies in separating the splenic veins surrounded by pancreatic tissue and preserving the splenic arteries and veins.

The slightest negligence during this process may lead to tearing of the splenic blood vessels, which will not only make it impossible to save the spleen, but may also cause massive bleeding during the operation. The surgeon's technical level is very high and no mistakes are allowed during the operation.

This time, the operation was performed using laparoscopy. Compared with the traditional open pancreatic surgery which often requires a large incision of 20-30 cm, the incision of minimally invasive surgery is only 1.2 cm long, which can significantly reduce the patient's pain and shorten the postoperative recovery time and hospitalization time. This diagnosis and treatment also reflects the hospital's precision treatment level for difficult and complicated diseases under the multidisciplinary collaborative diagnosis and treatment model.

Hunan Medical Chat Special Author: Zeng Hui, General Surgery Minimally Invasive Center, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)