Arteriography with simultaneous gastric distention to detect insulin-secreting tumors of the pancreas.

Gaseous distention of the stomach at the time of arteriography enhances the contrast of densities within the pancreatic parenchyma, resulting in excellent visualization and therefore precise preoperative localization of insulin-secreting tumors of the pancreas. This relatively simple modification of selective arteriography was used in the last three consecutive patients we have seen with insulinomas. Apparently, the presence of air in the stomach makes the "tumor blush" that results from the uptake of the contrast dye by the vessels within the insulinoma and is clearer than in selective arteriography alone. The stomach was distended at the time of selective arteriography with carbonated soft drinks in two cases and by gas-producing pills in one. In all three cases, the location of the tumor shown by arteriography coincided exactly with the operative findings. Distal pancreatectomy was required in two; enucleation of the insulinoma was possible in one. All three patients recovered from operation uneventfully and were completely relieved of symptoms.