XXXX . A diagnosis of exclusion. A case for duodenotomy in the setting of a negative imaging for primary tumor: A case report and review of the literature.

@entity1 @entity1600 @entity8579 @entity8243 @entity7581
INTRODUCTION: @entity8579 ( @entity8579 ) is caused by uninhibited secretion of @entity8243 from a @entity7581 . Gastrinomas most commonly arise within the wall of the duodenum followed by the pancreas. @entity1600 have also been reported in the literature. This is a case of @entity8579 where preoperative localization revealed a @entity7581 in a solitary portacaval lymph node, presumed to be a primary lymph node @entity7581 . PRESENTATION OF CASE: The @entity1 is a 57 year old female diagnosed with @entity8579 , suspected of having a primary lymph node @entity7581 . The @entity1 underwent an exploratory laparotomy and excision of a portacaval lymph node with a frozen section which was positive for @entity7581 . Intraoperative sonography of the pancreas, upper endoscopy with transillumination of the duodenum, and a duodenotomy with bimanual examination of the duodenal wall were also performed. The @entity1 was found to have a 4mm duodenal mass near the pylorus, which was excised. DISCUSSION: Pathology showed that the duodenal mass was primary @entity7581 . Serum @entity8243 levels taken four months postoperatively were normal and the repeat octreotide scan did not show any evidence of recurrence. CONCLUSION: @entity1600 is a diagnosis of exclusion. The duodenum and pancreas must be fully explored to rule out a primary @entity7581 that may be occult.
