A 34-year-old man has three years of episodic confusion, sweating and palpitations relieved by eating. During an attack, plasma glucose is 2.1 mmol/L with an inappropriately elevated insulin level and negative sulfonylurea screen. Contrast-enhanced CT localizes a 14 mm enhancing lesion in the tail of the pancreas. The preferred surgical treatment is:

• A Enucleation of the tumour ✓
• B Distal pancreatectomy with splenectomy
• C Total pancreatectomy
• D Whipple's pancreaticoduodenectomy

Explanation

The biochemical picture confirms insulinoma, the commonest functional pancreatic neuroendocrine tumour. Over 90 percent are solitary, benign and less than 2 cm, so once localized, enucleation preserves maximal parenchyma and avoids the diabetes risk of major resection. Intraoperative ultrasound supplements localization. Distal pancreatectomy is reserved when the tumour abuts the main duct or proves malignant, and extensive resections are unwarranted for benign disease.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.