Near-total pancreatectomy in persistent infantile hypoglycemia
F. Moazam, B. M. Rodgers, J. L. Talbert and A. L. Rosenbloom
To prevent the devastating effects of hypoglycemia on the CNS of the
infant, persistent infantile hypoglycemia should be recognized early and
treated promptly. To avoid mental retardation, surgical intervention should
not be considered as a last resort. When an insulinoma is identified at
surgery, subtotal pancreatectomy is adequate in achieving normoglycemia.
However, the most common cause of insulin excess in infancy appears to be
islet cell hyperplasia or nesidioblastosis, both diffuse processes. In
these patients, subtotal pancreatectomy is often ineffective in achieving
normoglycemia. Near-total pancreatectomy, retaining the spleen and
duodenum, is a safe procedure, well tolerated by infants and children, and
should be considered early for the correction of hypoglycemia of infancy
that is not readily controlled by medical intervention.
