Insulinomas are the most common pancreatic neuroendocrine tumors. Most insulinomas are benign, small, intrapancreatic solid tumors and only large tumors have a tendency for malignancy. Most patients present with symptoms of hypoglycemia that are relieved with the administration of glucose. We herein present the case of a 75-year-old woman who presented with an acute hypoglycemic episode. Subsequent laboratory and radiological studies established the diagnosis of a 17-cm malignant insulinoma, with local invasion to the left kidney, lymph node metastasis, and hepatic metastases. Patient symptoms, diagnostic and imaging work-up and surgical management of both the primary and the metastatic disease are reviewed.
Aged ; Diagnosis ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Kidney ; Lymph Nodes ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors

We report a case of successful open repair of a 7.5-cm juxtarenal abdominal aortic aneurysm (AAA) in the presence of a left-sided inferior vena cava (LS-IVC) crossing the aorta at the level of the renal arteries in a 72-year-old man. The orifice of the right renal artery was slightly caudal to that of the left renal artery and concomitant occlusive diseases of both iliac arteries were present. Based on the imaging and intraoperative findings, repair of the juxtarenal AAA was performed with mobilization of the LS-IVC, which was encircled twice with soft silicone rubber vessel loops on both sides of operating field and the blood content of the LS-IVC was temporarily evacuated. This procedure allowed proximal control with inter-renal clamping of the aorta and placement of an aortobifemoral polytetrafluoroethylene graft.

We report a case of successful open repair of a 7.5-cm juxtarenal abdominal aortic aneurysm (AAA) in the presence of a left-sided inferior vena cava (LS-IVC) crossing the aorta at the level of the renal arteries in a 72-year-old man. The orifice of the right renal artery was slightly caudal to that of the left renal artery and concomitant occlusive diseases of both iliac arteries were present. Based on the imaging and intraoperative findings, repair of the juxtarenal AAA was performed with mobilization of the LS-IVC, which was encircled twice with soft silicone rubber vessel loops on both sides of operating field and the blood content of the LS-IVC was temporarily evacuated. This procedure allowed proximal control with inter-renal clamping of the aorta and placement of an aortobifemoral polytetrafluoroethylene graft.