CC BY 4.0 · European J Pediatr Surg Rep. 2022; 10(01): e9-e12
DOI: 10.1055/s-0042-1742780
Case Report

Indocyanine Green (ICG)-Guided Identification of Hypermetabolic Pancreatic Nodules in Focal Congenital Hyperinsulinism: A Case Report in a 3-Month-Old Infant

1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
María del Carmen Sarmiento
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
Miriam Miguel-Ferrero
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
Nuria Leal
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
Saturnino Barrena
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
,
Leopoldo Martínez
1   Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain
2   Institute for Biomedical Research La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
› Author Affiliations
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Abstract

Indocyanine green (ICG)-guided near-infrared fluorescence has been recently adopted in pediatric surgery, although its use in the treatment of congenital hyperinsulinism has not been reported. We present a case of focal congenital hyperinsulinism in which ICG-navigation with ICG was used during surgical treatment. A 3-month-old infant was referred to our institution from a peripheral hospital for episodes of persistent hypoglycemia since birth, with no response to intravenous treatment with diazoxide, octreotide, or hydrochlorothiazide. An abdominal positron emission tomography-computed tomography scan showed a hypermetabolic nodule in the proximal portion of the body of the pancreas, compatible with focal congenital hyperinsulinism. A heterozygous mutation in the ABCC gene (Ala1516Glyfs*19) frameshift type inherited from the father was identified, which supported this diagnosis. Laparoscopy-assisted surgery was performed with ICG-guided near-infrared fluorescence, with intravenous injection of 16 mg ICG (2 mg/mg), which allowed localization of the focal lesion in the body of the pancreas. The lesion was resected with bipolar electrocautery and intraoperative histological study confirmed complete resection. Plasma glucose values normalized 6 hours after surgery and the patient was discharged 5 days later. In conclusion, the use of ICG in the treatment of congenital hyperinsulinism helps to identify hypermetabolic pancreatic nodules, decreasing the likelihood of incomplete resection.



Publication History

Received: 03 August 2021

Accepted: 23 November 2021

Article published online:
08 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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