PMC4245667_01
Computed tomography (CT) scan of abdomen. (a) Portacaval node on CT scan of abdomen, corresponding to area of abnormal octreotide uptake on octreotide scan. (b) Intraoperative image of the portocaval node which was positive for gastrinoma on frozen and final pathology.
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Preoperative octreotide scan demonstrated an area of focal abnormal octreotide uptake that corresponded to an enhancing portacaval node seen on CT (Fig. 1a) and on contrast-enhanced MRI. The right colon was mobilized and the duodenum Kocherized to reveal the pathological portacaval node (Fig. 1b) situated just posterior to the head of the pancreas and portal triad, and anterior to the vena cava.
Excision of gastrinoma. (a) Manual palpation of duodenum after duodenotomy. (b) Duodenal nodule, found to be gastrinoma. (c) Defect in the duodenal wall after enucleation, this was primarily closed.
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Digital and bimanual examination of the entire wall of the duodenum (Fig. 2a) from the pylorus to the third portion was performed. The nodule was excised full thickness from the outer duodenal wall (Fig. 2b and c) and a frozen section submitted to pathology was consistent with a gastrinoma.