DEMONSTRATION OF AN EXTRAPANCREATIC AND E XTRAINTESTINAL GASTRINOMA BY ENDOSONOGRAPHY

History and clinical findings: No cause had been found for chronic dia rrhoea in a 57-year-old man. Up to 15 watery stools daily had been wit hout relation to food intake and without blood admixture. But muscular cramps had developed, especially in the legs. The patient had a histo ry of recurrent peptic ulcers for which a selective proximal vagotomy had been performed 13 years ago. Physical examination was unremarkable . Investigations: Alkaline phosphatase activity (182 U/l) and C-reacti ve protein (9.3 mg/l) were slightly raised; serum iron was 42 mu g/dl, while all other routine laboratory tests, including protein electroph oresis, blood picture and differential count were within normal limits . Gastroscopy revealed ulcerative duodenitis, gastritis with erosions and numerous ulcers and reflux oesophagitis, grade III-IV. Endosonogra phy showed enlarged gastric mucosal relief as sign of foveolar hyperpl asia and a ca. 4 x 3 cm tumour next to the duodenal bulb. Gastrin leve l was 7537 pg/ml (normal < 150 pg/ml). Computed tomography and somatos tatin receptor scintigraphy confirmed the site and size of the gastrin oma.Treatment and course: Treatment with omeprazole (40 mg three times daily) slightly improved the symptoms. The tumour was excised a week after diagnosis. The patient has been symptom-free since then. Conclus ion: Chronic diarrhoea of unknown aetiology can be caused by an endocr ine tumour; endosonography can often provide information on the diagno sis and location of such a tumour.