Case Report
Modified Frey Technique for Treatment of Persistent Hyperinsulinemic Hyperglycemia Due to Nesidioblastosis: A Case Report
Issue:
Volume 13, Issue 3, June 2025
Pages:
45-50
Received:
14 March 2025
Accepted:
14 April 2025
Published:
29 May 2025
Abstract: Introduction: Hypoglycemia in non-diabetic individuals is rare but represents a significant diagnostic and therapeutic challenge. One of its uncommon causes is Nesidioblastosis, characterized by diffuse or focal hyperplasia of pancreatic β cells, leading to endogenous hyperinsulinemic hypoglycemia. Although more frequent in neonates, cases in adults have been increasingly recognized, especially in the absence of insulinoma. In adults, this condition presents with β cell hypertrophy, enlarged islets, and hyperchromatic nuclei, with postprandial hypoglycemia being its main symptom. This article aims to demonstrate a technical modification for preserving the duodenum and bile duct in the treatment of a patient with Nesidioblastosis who underwent several surgical treatments without results. Case Presentation: This article reports the case of a man with intermittent symptomatic hypoglycemia for two years, who required multiple surgical interventions for effective control of the disease. Was done a technical modification for preserving the duodenum and bile duct in the treatment of a patient with Nesidioblastosis who underwent several surgical treatments without results. Given the current clinical picture, in which a pancreaticoduodenectomy with total resection of the remaining pancreas would be indicated due to hypoglycemia refractory to several types of clinical and surgical treatments, we decided to perform the Frey technique for this case, thus preserving a small segment of the pancreas together with the duodenal arch and thus preserving the main bile duct. Discussion and Conclusion: Preoperative diagnosis is challenging due to the nonspecificity of symptoms and the absence of specific functional tests and is usually confirmed by histopathological examination after surgery. Initial treatment involves nutritional modifications and the use of medications. However, moderate to severe and refractory cases require surgical intervention. Partial or subtotal pancreatectomy is effective, although some cases require multiple surgeries. In the reported case, the Frey technique was successfully used, promoting effective glycemic control and minimizing gastrointestinal complications. Despite partial preservation of the pancreas, the patient developed postoperative diabetes, highlighting the importance of balancing effective removal of hyperfunctioning tissue and preservation of pancreatic function. It is concluded that surgical treatment as a last resort and using the technique described by Frey as a way to preserve the gastrointestinal tract and avoid total pancreatectomy with its serious repercussions on the patient's metabolism.
Abstract: Introduction: Hypoglycemia in non-diabetic individuals is rare but represents a significant diagnostic and therapeutic challenge. One of its uncommon causes is Nesidioblastosis, characterized by diffuse or focal hyperplasia of pancreatic β cells, leading to endogenous hyperinsulinemic hypoglycemia. Although more frequent in neonates, cases in adult...
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Case Report
Traumatic Female Urethral Avulsion Associated with Pelvic Fracture: A Case Report
Issue:
Volume 13, Issue 3, June 2025
Pages:
51-54
Received:
5 April 2025
Accepted:
15 April 2025
Published:
20 June 2025
DOI:
10.11648/j.js.20251303.12
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Abstract: Traumatic female urethral avulsion is rare and there are no consensus in the management. There is also paucity of report of similar case in tropical Africa. Most cases of female urethral injury are partial tears. Complete female urethral avulsion is uncommon and usually traumatic in origin from road traffic accident or fall from height. We present a 55 year old post-menopausal woman who had a complete circumferential transection of the urethra with extensive posterior and anterior vaginal wall laceration following pelvic fracture and also a left hand injury from a motor vehicular accident. The aim reporting this case is to increase the awareness of traumatic female urethral avulsion injury with pelvic fractures in a poly-traumatized patient post-menopausal female and emphasize the place of immediate primary repair in achieving optimal outcome. The management can be very challenging because the impact can involve the pelvic bone, bladder, vagina and rectum with will invariably increase morbidity and mortality. This patient was managed in a multidisciplinary approach which consisted of primary repair of the urethra and vaginal lacerations as well as repair of the hand injury with conservative management of pelvic fracture. The outcome was favorable and uneventful as the anatomic function of all involved structures were restored.
Abstract: Traumatic female urethral avulsion is rare and there are no consensus in the management. There is also paucity of report of similar case in tropical Africa. Most cases of female urethral injury are partial tears. Complete female urethral avulsion is uncommon and usually traumatic in origin from road traffic accident or fall from height. We present ...
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,
Fernando Freire Lisboa Junior
