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A 74-year-old man was hospitalized for chronic diarrhea and weight loss. His medical history included hypertension and peptic gastric ulcers, which were treated with atenolol and proton pump inhibitors, respectively. He had no history of travel in tropical regions. Laboratory test results and a colonoscopy were normal. An abdominal computed tomographic scan revealed evidence of a hypervascularized mass, 4 cm in diameter, located in the first part of the duodenum associated with a pericephalic pancreatic adenopathy, 22 mm in diameter (Figure 1), both hyperfixating on a somatostatin receptor scintigraphy (Figure 2). There were no other fixating lesions on the somatostatin receptor scintigraphy.
Abdominal computed tomographic scan.
Somatostatin receptor scintigraphy.
A. Peutz-Jegher hamartoma
B. Sporadic duodenal macrogastrinoma
C. Celiac disease
D. Duodenal vipoma
Jarry J, Rault A, Peycru T, Sa Cunha A, Collet D. Image of the Month—Quiz Case. Arch Surg. 2011;146(1):113. doi:10.1001/archsurg.2010.298-a