Editorial
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 7, 2008; 14(5): 657-665
Published online Feb 7, 2008. doi: 10.3748/wjg.14.657
Occult sporadic insulinoma: Localization and surgical strategy
Bassam Abboud, Joe Boujaoude
Bassam Abboud, Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 166830, Lebanon
Joe Boujaoude, Department of Gastroenterology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 166830, Lebanon
Author contributions: Abboud B and Boujaoude J designed research; Abboud B and Boujaoude J performed research, Abboud B wrote the paper
Correspondence to: Bassam Abboud, MD, Department of General Surgery, Hotel Dieu de France Hospital, Alfred Naccache Street, Beirut 166830, Lebanon. dbabboud@yahoo.fr
Telephone: +961-1-615300
Fax: +961-1-615295
Received: November 21, 2007
Revised: December 3, 2007
Published online: February 7, 2008
Abstract

Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.

Keywords: Insulinoma; Occult; CT scan; Endoscopic ultrasonography; Surgery; Laparoscopy