The manuscript presents, for the first time, an overview of the different developments and needs to manage intestinal failure patients in MIC from Latin America and Asia. Future discussions will emerge from this manuscript, aiming to pursue the development of registries, guidelines and health policies to continue improving the long-term care of intestinal failure patients in all MIC.
Background
Hyperinsulinemic hypoglycemia is the most common cause of severe and persistent hypoglycemia in neonates and children. It is a heterogeneous condition with dysregulated insulin secretion, which persists in the presence of low blood glucose levels.
Case presentation
We report a case of a 15 year-old male with hyperinsulinemic hypoglycemia, who underwent a subtotal pancreatectomy after inadequate response to medical therapy. Pathological examination was positive for nesidioblastosis (diffuse β-cell hyperplasia by H-E and immunohistochemical techniques). The patient’s blood glucose levels normalized after surgery and he remains asymptomatic after 1 year of follow-up. The systematic review allowed us to identify 41 adolescents from a total of 205 cases reported in 22 manuscripts, from a total of 454 found in the original search done in PubMed and Lilacs.
Conclusions
Although very well reported in children, hyperinsulinemic hypoglycemia can occur in adolescents or young adults, as it happens in our reported case. These patients can be seen, treated and reported by pediatricians or adult teams either way due to the wide age range used to define adolescence. Most of them do not respond to medical treatment, and subtotal distal pancreatectomy has become the elected procedure with excellent long-term response in the vast majority.
pancreaticoduodenectomy (PDC) and 3 patients (21.5%) underwent a distal pancreatectomy (PD). All PD were performed by laparoscopy associated with splenectomy. Morbidity was present in 7 patients (50%), not showing major morbidity (Clavien-Dindo ! IIIa). There was no statistically significant difference in the group younger than 80 years (p = 0.129). The mean hospitalization days was 15 AE 0 and 5 AE 1 for PDC and PD respectively, showing no difference from the group younger than 80 years (p = 0.173; p = 0.492). There was no perioperative mortality or at 30 days after surgery. Conclusion: This group of patients does not present greater morbidity and mortality than patients under 80 years operated in our institution and is compatible with what is described in the international literature. P 136.
Acute weakness may occur after LT due to various causes, DMS and US may be feasible for diagnosis of ICUAW. Early diagnosis of ICUAW may lead to earlier physiotherapy.
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