Nesidioblastosis del adulto tras derivación gástrica
DOI:
https://doi.org/10.30944/20117582.40Palabras clave:
nesidioblastosis, derivación gástrica, complicaciones posoperatorias, síndrome de vaciamiento rápido, hipoglucemia, hiperinsulinismoResumen
La hipoglucemia por hiperinsulinismo endógeno ha sido descrita como una complicación de la cirugía bariátrica. Se presenta el caso de un hombre de 34 años con tríada de Whipple que se manifestó ocho años después de someterse a derivación (bypass) gástrica.
La hipoglucemia se asociaba con niveles elevados de insulina y péptido C, pero la localización del hiperinsulinismo endógeno solo se pudo precisar mediante cateterismo de arterias pancreáticas con estimulación intraarterial selectiva con calcio. Se decidió practicar una pancreatectomía subtotal laparoscópica, después de la cual el paciente presentó una excelente evolución posoperatoria y mejoró significativamente su sintomatología. Mediante la evaluación histopatológica e inmunohistoquímica, se confirmó una nesidioblastosis del adulto.
Es importante reconocer esta enfermedad como una complicación de la cirugía bariátrica, más aún cuando estos procedimientos son tan frecuentes en la actualidad debido a la epidemia de obesidad. Los síntomas se pueden confundir con los de un síndrome de evacuación gástrica rápida (dumping), el cual no tiene repercusiones tan graves sobre la salud del paciente, como sí la tiene la nesidioblastosis.
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