Laparoscopic Spleen-preserving Distal Pancreatectomy for Insulinoma: Rapid Glycemic Resolution in a 44-year-old Male: A Case Report

Abstract

tremors, most notably occurring when he skipped meals.His symptoms were initially resolved with food, but in the recent few months, the patient needed dextrose infusion.Capillary blood glucose measured during one such episode was 35 mg/dL.A supervised 72-hour fast confirmed endogenous hyperinsulinemia, with elevated insulin (12 µU/mL), C-peptide (2.1 ng/mL), and proinsulin levels.A contrast-enhanced CT scan revealed a 2.5 cm hypervascular mass located in the tail of the pancreas.The lesion exhibited early arterial enhancement with subsequent washout during the portal venous phase, a characteristic imaging feature of insulinoma IntroductIonInsulinomas are rare functional pancreatic neuroendocrine tumors with an estimated incidence of one to four cases per million population annually.These tumors are typically benign and solitary, arising from beta cells of the pancreas, and they are characterized by inappropriate insulin secretion leading to recurrent hypoglycemia.Patients often present with symptoms of neuroglycopenia (e.g., confusion, blurred vision, seizures) and adrenergic activation (e.g., palpitations, sweating, tremors), which are rapidly reversed by glucose intake. 1 Diagnosis is based on Whipple's triad, confirmed by biochemical evidence of endogenous hyperinsulinism and tumor localization through imaging such as computed tomography (CT), magnetic resonance imaging (MRI), or endoscopic ultrasound. 2 Surgery remains the definitive treatment for insulinoma.With advancements in minimally invasive surgery, laparoscopic distal pancreatectomy has become the preferred approach for tumors located in the pancreatic body and tail.3 Preservation of the spleen, particularly via the Kimura technique, which maintains the integrity of the splenic artery and vein, is favored to reduce postoperative infectious and hematologic complications. 4 In this report, we describe a case of laparoscopic spleen-preserving distal pancreatectomy for a solitary insulinoma, highlighting both technical considerations and rapid postoperative glycemic normalization.

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