Last week I had a patient with a diagnosis of insulinoma. The work up imaging including EUS did not locate the mass. Intraoperative US was also unsuccessful and I did distal pancreatectomy and the clinical manifestation diappeared. What do you do in this situation if you do not have access for Venus sampling?
introperative US has more than 88% sensitivity? maybe could try GLP-1R scintigraphy or [18F]DOPA PET imaging
A well done DT, in particular with the right timing of arterous contrast phase, can detect mostly of the lesions. The radiologist should be expert and the question should be very clear.
You should have an option for intraoperative selective calcium gluconate stimulation and sampling of hepatic venous insulin and C-peptide, if this was not done preoperatively in a patient with imagimg-obscure insulinoma. Otherwise better refer the patient to a center with these possibilities. There is always a risk to leave in place undetected lesion if you do blind resection!
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