Evelyn A Dorado, MD
Unit Laparoscopic Surgery CES University
INTRODUCTION: Multiple endocrine neoplasias (MEN) are syndromes inherited as autosomal dominant. The application of the techniques of molecular biology has made possible the identification of the genes causing MEN 1 and 2.the incidence of 1/300 to 50.000 cases and affected glands are endocrine (pituitary, parathyroid ,enteropancreatic tissue). In addition to this triad, described the Association of adrenal cortical tumors and carcinoid, facial angiofibromas, colagenomas lipomas. Its clinical presentation is highly variable, and may undertake one or the three aforementioned glands.
MAIN: Describe two cases of patients with NEM 1 were successfully managed by laparoscopic surgery (resection of duodenal gastrinoma and right adrenal adenoma).
MATERIALS AND METHODS: two patients operated between January-may of 2012 with radiologic and biochemical diagnosis of NEM-1 syndrome . Case 1: male patient 45 year old with pituitary, parathyroid adenoma and chronic duodenal ulceration with Zollinger-Ellison syndrome. Case 2: female 48 year old with pituitary, parathyroid and adrenalnadenoma, cushing syndrome hipertension and diabetes difficult rmanagement. CTA SCAn and gammagraphy shown the lesions. . Neurosurgery conducted resection of pituitary adenoma.
RESULT: Case 1: with separate legs lithotomy position 4 trocars, the procedure starts withta laparoscopic kocher manoeuvrer and and subsequent dissection of the first three portions of the duodenum until the mesenteric vessels, on the wall of the second portion of the duodenum is identified a solid lesion of 2 x2 cm, resected with bipolar energy and is sent to biopsy by freezing to confirm the diagnosis, complete the revision of the fourth portion of the duodenum with handport. Operative time 60 minutes.24-hour hospitalization. Pathology: neuroendocrine tumor. Case 2. left lateral decubitus with hip flexion, 4 ports, disection with bipolar the adrenal gland with a 4 x 5 cm size .Operative time 30 minutes. Pathology: Adrenal Adenoma.
CONCLUSION: the multiple Endocrine Neoplasm are rare, the presence of Zolligier Ellinson Syndrome reported 10-48% and islet cell tumors (33%) and less frequent, glucagonoma, producing PP or VIP (vasoactive intestinal peptide) tumors (polypeptide pancreatic). Gastrinomas are the leading cause of morbidity and mortality. Nearly 60% of them are malignant and half of the patients already have metastasis at the time of diagnosis. Minimally invasive management of this abdominal pathologies has proven to be effective and with good results , short hospital stays and resumption of activities early.
Session: Poster Presentation
Program Number: P474
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