A Completely Resected Case of Intraduodenal Malignant Gastrinoma by Utilizing Selective Arterial Secretin Injection Test and Intra-operative Secretin Test

The patient was a 35-year-old woman, whose chief complaints were nausea and vomiting. Her illness was diagnosed as Zollinger-Ellison syndrome by a high serum level of gastrin in the fasting state and by a paradoxical increase in serum gastrin induced by a secretin test. A tumor outline at the pancreatic head was observed on the celiac angiogram. The gastroduodenal artery was found to be the artery feeding the tumor by using a selective arterial secretin injection test. Three tumors were found at the head of the pancreas during surgery, one of which was considered to correspond to the tumor stain observed on the angiogram. Pancreatoduodenectomy was performed and completeness of the resection was assured by an intra-operative secretin test. Histological examination revealed that a 5-mm primary gastrinoma was present in the submucosal layer of the duodenum and that the three tumors found during the operation were its metastases. A secretin test performed after the operation was negative. This case indicates the possibility of resecting the primary tumor completely by performing both a selective arterial secretin injection test and an intra-operative secretin test in patients with Zollinger-Ellison syndrome.