The management of islet cell tumors requires a thorough knowledge of pancreatic anatomy and embryology. Optimal surgical exposure and meticulous intraoperative evaluation of the pancreas are necessary to identify tumor masses, which are frequently less than 2 cm in size. The surgeon should understand the anatomy of the pancreatic duct and be able to determine its proximity to the tumor. Intraoperative ultrasonography is a useful study for localizing tumors of the endocrine pancreas and may help define the relationship of an islet cell tumor to the pancreatic duct. The gastrinoma triangle, duodenum, and peripancreatic lymph nodes are other potential sites for extra pancreatic islet cell tumors. In most patients, resection of an islet cell tumor can be accomplished by enucleation. When pancreatic resection is necessary, the surgeon should be aware of the potential anomalous arterial supply and be able to recognize the arterial anomalies when they occur in order to avoid injury.


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chapter 76

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