Teresa Berrocal MD, Abstract Co-Author: Nothing to Disclose

Inmaculada Pinilla MD, Presenter: Nothing to Disclose

Arturo Alvarez MD, Abstract Co-Author: Nothing to Disclose

Luis Lassaleta MD, Abstract Co-Author: Nothing to Disclose

Leopoldo Martinez MD, Abstract Co-Author: Nothing to Disclose

Pilar Cortés MD, Abstract Co-Author: Nothing to Disclose

Nesidioblastosis (persistence of the fetal pancreas) is the most common cause of severe neonatal hypoglycemia. If hypoglycemia is resistant to conservative therapy, subtotal pancreatectomy is recommended. Our aim is to report pancreatic regeneration without recurrent hypoglycemia several years after subtotal (90-95%) pancreatectomy in patients with nesidioblastosis, as demonstrated by ultrasound (US) measurements.

Twenty-two patients (aging 9 days to two years) diagnosed of nesidioblastosis underwent 90-95% pancreatectomy, preserving the head and common bile duct. In all cases a preoperative US study, an immediate postoperative US control within 10 days after surgery, and a long-term US follow-up (3-8 years after surgery) were performed. In the preoperative study three anteroposterior measurements were obtained at the head, body, and tail of the pancreas. In the postoperative and long-term follow-up US anteroposterior and transverse measurements of the pancreatic remnant were obtained after filling the stomach with water. The pancreatic remnant echogenicity was also assessed. Results were compared with normal standard of pancreatic sizes as a function of age. The glucose metabolism and pancreatic enzymes were analyzed in every control.

In the preoperative US all pancreas were normal. In the postoperative control, all patients showed a remnant of pancreatic tissue at the pancreatic head, with an anteroposterior diameter between 8 and 13 mm. The long-term follow-up was similar to postoperative control in 6 patients. Twelve patients presented complete pancreatic regeneration. In these cases the size of the pancreas was the correspondent to the patient age, and the echogenicity and pancreatic function were normal. Four patients had an incomplete regeneration, with a pancreatic head and body normal in size, but lack of pancreatic tissue at the pancreatic tail area. All patients were asymptomatic and showed normal pancreatic tests.

The US measurements indicate normal age-dependant growth after subtotal resection in about 50% of patients. The function and echogenicity of the regenerated pancreas indicate that the increase in organ size was due to normal pancreatic tissue.

Berrocal, T, Pinilla, I, Alvarez, A, Lassaleta, L, Martinez, L, Cortés, P, Pancreatic Regeneration after Subtotal Pancreatectomy in Patients with Nesidioblastosis.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405280.html