Boateng William K, Ezeh Kosisochukwu J, Botros Youssef, Spira Etan, Shen Tingliang
Internal Medicine, Jersey City Medical Center, Jersey City, USA.
Gastroenterology and Hepatology, Jersey City Medical Center, Jersey City, USA.
Cureus. 2024 Jul 19;16(7):e64894. doi: 10.7759/cureus.64894. eCollection 2024 Jul.
A gastrointestinal bleed (GIB) in the setting of metastatic insulinoma is a rare phenomenon. It appears that cases of metastatic insulinoma causing GIB are rare, often influenced by the tumor's location. Our case involves an 82-year-old male with dementia and a history of recurrent hypoglycemia, presenting with an episode of altered mental status. The patient exhibited hypoglycemia alongside a melena episode and anemia. Diagnostic criteria, including Whipple's triad, confirmed endogenous insulin production. Computed tomography (CT) showed a left paraaortic/retroperitoneal mass. Esophagogastroduodenoscopy (EGD) visualized an extrinsic mass at the gastric body, which caused an ulcerated surface that was treated with clipping and hemostasis. The patient's recurrent hypoglycemic episodes were treated with glucose, while his GIB was managed with hemostasis and clipping. However, the patient was not a surgical candidate, and further medical treatment was ceased by the family.
转移性胰岛素瘤患者发生胃肠道出血（GIB）是一种罕见现象。转移性胰岛素瘤导致GIB的病例似乎很少见，常受肿瘤位置影响。我们的病例是一名82岁男性，患有痴呆症且有反复低血糖病史，此次因精神状态改变就诊。患者出现低血糖，同时伴有黑便和贫血。包括惠普尔三联征在内的诊断标准证实存在内源性胰岛素分泌。计算机断层扫描（CT）显示左主动脉旁/腹膜后肿块。食管胃十二指肠镜检查（EGD）发现胃体有一外在肿块，该肿块导致表面溃疡，进行了钳夹止血治疗。患者反复出现的低血糖发作通过葡萄糖治疗，而其GIB则采用止血和钳夹处理。然而，该患者不适合手术，家属停止了进一步的药物治疗。
