A case report of Zollinger Ellison syndrome and review of the literature.

There is much controversy concerning the mode of therapy for patients in whom Zollinger-Ellison syndrome is strongly suspected but a tumor can not be located. We recently experienced a patient with Zollinger-Ellison syndrome presenting with melena in whom an attempt to stop the bleeding by H-2 antagonists failed and an emergency operation had to be carried out. At laparotomy, no tumor was found in the pancreas, duodenum or stomach wall and there was no specific swelling in any of the lymph nodes. A total gastrectomy was thus done with lymphadenectomy and a histopathological examination revealed two gastrinomas in the lymph nodes of the gastrinoma triangle. Postoperative secretin tests with 2 u/kg of secretin have been negative even 6.5 years later, and the patient is now well and working as a full time teacher. In this case, an emergency total gastrectomy was performed for uncontrolled bleeding, but we want to stress the importance of lymphadenectomy based on the findings of the frozen section and changes in gastrin levels.