ABSTRACT Combinations of strategies as MRI, endoscopic sonography, selective arteriography, were the first choice for the detection of pancreatic insu-linoma. In these proposal, therefore, abdominal was not in- cluded at all. Case presentation: a 78-year-old no diabetic women was referred to us because fasting hypoglycemic symptoms. The clinical and laboratory findings suggested an insulinoma. Abdominal ultrasound showed a small solid mass in the head-istmus pancreatic tract. Conclusion: the solid mass was confirmed with a contrast-enhanced- computed tomogra-phy of the abdomen. A surgical enucleation of the tumor was achieved by laparoscopy and histological examination of the specimen estab-lished a diagnosis of insulinoma. This case re-inforced the value of the conventional trans- abdomen ultrasound in addition to accuracy of anamneses and biochemical tests as the first step in the hospital clinical setting for man-agement of pancreatic insulinoma, reserving as the second step more expensive and invasive-ness techniques.
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