A patient with Zollinger-Ellison syndrome (ZES) is referred for surgical evaluation. Secretin stimulation test shows a paradoxical rise in serum gastrin >200 pg/mL. Imaging shows a 1.2 cm lesion in the duodenal wall (first part). The relevant surgical anatomy dictates that most sporadic gastrinomas are located within the 'gastrinoma triangle.' Which anatomical boundaries define this triangle?

• A Porta hepatis, splenic hilum, and pancreatic tail
• B Confluence of the cystic and common bile ducts superiorly, junction of the head and neck of the pancreas medially, and junction of the second and third parts of the duodenum inferiorly ✓
• C Cystic duct, neck of pancreas, and aorto-caval groove
• D Foramen of Winslow, ampulla of Vater, and splenic artery

Explanation

The gastrinoma triangle (Passaro's triangle) is defined by: (1) the junction of the cystic duct and common bile duct superiorly, (2) the junction of the second and third parts of the duodenum inferiorly, and (3) the junction of the head and neck of the pancreas medially. Approximately 90% of gastrinomas are found within this triangle, with 60–70% in the duodenal wall and 20–30% in the pancreatic head. Recognising this triangle guides intraoperative exploration, including duodenotomy for small intramural duodenal gastrinomas that may be missed on preoperative imaging.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.