The Zollinger-Ellison syndrome A case report

A vagotomy and antrectomy was performed on a 15-year-old 'boy with a malignant gastrinoma for emer-gency control of massive upper gastro-intestinal haemorrhage from a large posterior penetrating duodenal ulcer in the presence of jejunal ulceration and liver metastases. Hypergastrinaemia was con-firmed by elevated serum gastrin levels. In the short term postoperatively the patienfs disease has been controlled with oral cimetidine. Although controversy continues over the efficacy of cimetidine in the management of gastrinomas, medical treatment should be considered as an alternative to total gastrectomy in chirdren with malignant gastrinomas ~ because they are often stow-growing, indolent and compatible with long survival. S AIr _ J 1985; 68: 607-608. In 1955 Zollinger and Ellison1 described the aSSOClatlon of pancreatic islet cell lesions, gastric hypersecretion and peptic ulceration. Marks el al. 2 from Groote Schuur Hospital, Cape Town, reported 23 years ago on one of the earliest confirmed cases in South Africa. The Zollinger-Ellison syndrome (ZES) affects only about one per million individuals but presents formidable problems in clinical management.3 The medical options and the changing role of surgery in the management of patients with gastrinoma are discussed. Case report A 15-year-old boy was admitted to Tygerberg Hospital with a short history of severe upper gastro-intestinal haemorrhage, diarrhoea and weight loss. The boy was emaciated and anaemic with signs of hypo-volaemic shock due to severe blood loss. After a period of resuscitation the patient was subjected to 'urgent operation after gastroscopic examination had confirmed the presence of a duodenal ulcer. At laparotomy, an actively bleeding 2 x 2 cm posterior penetrating duodenal ulcer was observed. Truncal vagotomy, antrectomy and Billroth 11 gastrectomy were per-formed