Diario del páncreas Acceso abierto

Abstracto

Embolization for Insulinoma in Complicated Severe Obesity: Description of an Inoperable Case and Review of the Literature

Chiara Mele, Amelia Brunani, Bruno Damascelli, Vladimira Tichà, Gianluca Aimaretti, Massimo Scacchi, Paolo Marzullo

Context Insulinoma is a rare cause of obesity. In severely obese patients, high anesthesiological risk can prompt the use of local non-surgical ablative therapies.

Case report A seventy-two-year old female patient was referred to our institution for morbid complicated obesity by insulinoma of the pancreas head, sized 1.5 × 1.7 cm as assessed by computed tomography scan. Because the patient was considered inoperable due to progressively worsening comorbidities and was poorly responsive to diazoxide and other medical treatments, she was subjected to selective trans-catheter embolization. Due to partial disease control, the procedure was repeated, and led to shrinkage and partial necrosis of the tumor, followed by recovery of hypoglycemia. As a result, the patient lost 28 kg in bodyweight with marked reduction of abdominal adiposity, and achieved a significant clinical improvement. Four years post-procedure, mild recurrence of insulinoma-related symptoms was documented and diazoxide was restarted with full symptom response. At present, after 10-year follow-up, the patient is stable and the residual disease remains well controlled. Analysis of Literature suggests that selective trans-catheter embolization is a feasible, safe and repeatable procedure in patients who are elderly or poor candidate to surgery or if they refuse surgery, when harbouring single, well-defined, localized insulinoma.

Conclusion Considering its positive outcomes, non-surgical ablation of symptomatic insulinomas is a feasible, safe and beneficial alternative to surgery in selected patients.