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REPEATED SPELLS OF UNCONSCIOUSNESS – ADVANCED ENDOSCOPIC TEST TO THE RESCUE
India
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New Delhi, June 22, 2023:
Sudden loss of consciousness can be a very traumatising and frightening experience for many. The thoughts which run amok are ‘Was that a stroke? or some cardiac abnormality? One can only imagine that the trauma which patients experience when episodes occur repeatedly. Hypoglycemia or low blood glucose is a common cause of repeated loss of consciousness. Usually, this is seen in patients suffering from diabetes mellitus who experience hypoglycemia after taking their medication. But did you know that even a tumor can produce hypoglycemia? That’s right! The Institute of Liver, Gastroenterology and Pancreatico Biliary Sciences at Sir Ganga Ram hospital recently reported case of an ectopic insulinoma.
According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, “Recently, a middle-aged female, non-diabetic residing in Dubai was suffering from recurrent episodes of fainting spells, tremors and palpitations over the last 4-6 months. Doctors (in Dubai) evaluated her with multiple abdominal imaging studies like CT, MRI and other investigations but could not isolate the cause. She then visited ILGPS at SGRH for further evaluation and underwent a minimally-invasive advanced endoscopic procedure called endoscopic ultrasound (EUS)”.
According to Dr. Shrihari Anikhindi, Consultant Gastroenterologist and Therapeutic Endoscopist, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, “Elucidated by saying “EUS (endoscopic ultrasound) is a procedure which allows visualisation from within the gastrointestinal tract since the instrument is closer to many organs in the abdomen (Figure 1). Also, it has the added advantage of obtaining a biopsy, which makes it a very useful test for suspected tumors. In this patient, on meticulous screening with EUS, we found a small 1.4 x1.6 cm tumor near the duodenum (1st part of the small intestine) (Figure 2) . We extracted a sample via needle (also called FNAC) for testing under microscope which revealed an insulinoma”.
Prof. Anil Arora, added, “Insulinoma is rare tumor which secretes large amounts of insulin. It is seen 4 per 10,00,000 (1 million cases). Almost 98% cases are found in or near the pancreas, but 2% cases are found elsewhere in the body. These tumors are what we call ectopic or extra-pancreatic insulinomas. These tumors may be easily missed by CT scan and even MRI. In such cases, endoscopic ultrasound plays a crucial role in finding the tumor. However, even on the EUS, operator experience and skill are a confounding factor. Once we localised the tumor via the EUS, the patient was taken for surgical removal”.
Dr. Naimish Mehta, GI Surgeon at Sir Ganga Ram Hospital removed the tumor (Figure 3) using a minimally invasive laparoscopic approach. Post removal of the tumor, the patient is now completely symptom free.
He concluded by saying “Such cases need a high index of clinical judgement and added skill of advanced procedures to localise these small tumors. We are proud to have both in our armamentarium at Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital”.
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