Mind the tributary of the canal: Are stents necessary for insulinoma enucleation in proximity to a prominent Duct of Santorini: A case report and literature review

• Published in: Medicine (Baltimore) 2022-10, Vol.101 (43), p.e31211-e31211
• Main Authors: Liu, Tiantong, Xu, Qiang, Zou, Xi, Zhu, Liang, Zhao, Yupei
• Format: Article
• Language: English
• Subjects: Clinical Case Report; Drainage - methods; Humans; Insulinoma - pathology; Pancreatectomy - methods; Pancreatic Ducts - pathology; Pancreatic Ducts - surgery; Pancreatic Fistula - etiology; Pancreatic Fistula - pathology; Pancreatic Fistula - surgery; Pancreatic Neoplasms - pathology; Postoperative Complications - surgery; Stents - adverse effects; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000031211

We describe a case of insulinoma located extremely close to the accessory pancreatic duct (APD), but away from the main pancreatic duct (MPD). Previous studies showed insulinoma enucleation is a safe procedure for small benign tumors >3 mm distant from the MPD. However, in this case enucleation of the tumor led to unanticipated APD injury and grade B post-operative pancreatic fistula (POPF). We provide detailed records of clinical management and argue that enucleation of tumors near APD needs to be carefully weighed. The patient experienced a sudden increase of abdominal drain fluid and prolonged drainage time after a regular insulinoma enucleation surgery. APD damage during the enucleation. Drain fluid amylase concentration were regularly recorded and prolonged somatostatin analogs were administered. Amount of abdominal drain gradually decreased and the drain tube was removed on postoperative 37. Benign pancreatic tumor close to the APD need to be evaluated carefully and clinical evidence is warranted to affirm the necessity of placing a pancreatic duct stent before the surgery.