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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Indonesian Journal of Endocrinology Metabolism and Diabetes (InaJEMD)
Hasan Maulahela
Unknown Affiliation
Health Professions Medicine & Pharmacology Public Health

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Small Bowel Malignancy in Patient with Obscure Gastrointestinal Bleeding in Cipto Mangunkusumo Hospital, Diagnosed Using Double Balloon Enteroscopy: A Case Series Hasan Maulahela; Achmad Fauzi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, AUGUST 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (788.631 KB) | DOI: 10.24871/1822017118-121

Abstract

Small bowel malignancy is still a rare case as a cause of gastrointestinal bleeding. The symptoms of small bowel malignancy are not specific.  One of the symptoms is obscure gastrointestinal bleeding.  Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent gastrointestinal bleeding when the result esophagogastroduodenoscopy and colonic endoscopy is negative. OGIB accounts for approximately 5% of all gastrointestinal bleeding events. Most OGIB events are attributable to small bowel disease. Double-balloon enteroscopy, also known as push-and-pull enteroscopy is an endoscopic technique for visualization of the small bowel. Here we present 5 cases of small bowel tumours in patient with obscure gastrointestinal bleeding who underwent double balloon enteroscopy at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Three patients had confirmed gastrointestinal stromal tumour (GIST) from the histopathology examination, while 2 patients were diagnosed with adenocarcinoma.
Detection of Small Lesion Insulinoma with 68Ga-DOTATATE PET/CT scan: A Case Report Irma Wahyuni; Tri Juli Edi Tarigan; Hendra Budiawan; Alvita Dewi; Rian Hidayatullah; Hasan Maulahela
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

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Abstract

Endogenous hyperinsulinism is a rare condition characterized by inappropriate insulin secretion, with insulinoma accounting for approximately 55% of cases. A 36-year-old woman presented with recurrent hypoglycemic episodes for 4.5 years, particularly in the morning, relieved by glucose intake. Laboratory findings during a supervised fasting test revealed a blood glucose of 44 mg/dL, elevated insulin (15 μIU/mL), C-peptide (2.27 ng/mL), proinsulin (53.1 pmol/L), and suppressed beta-hydroxybutyrate (0.1 mmol/L), indicating endogenous hyperinsulinemia. Initial imaging modalities including CT, MRI, and EUS failed to localize the lesion. The patient discontinued investigation but resumed a year later with nuclear imaging studies. A 99mTc-HYNIC-TOC scan was inconclusive, but subsequent ^68Ga-DOTATATE PET/CT at Hasan Sadikin Hospital revealed a somatostatin receptor-expressing nodule at the pancreatic head, consistent with insulinoma. Given the lesion's location and imaging findings, treatment options were discussed, including Whipple’s procedure versus radiofrequency ablation. Insulinomas are typically small, with 80% under 2 cm and 40% under 1 cm, often making localization challenging. While CT and MRI have detection rates of 70% and 86% respectively, the combination of CT and EUS may reach 100% sensitivity. In cases where conventional imaging is inconclusive, ^68Ga-DOTATATE PET/CT provides a valuable alternative, capable of detecting neuroendocrine tumors as small as 6 mm. This case highlights the critical role of nuclear medicine in localizing elusive insulinomas and guiding definitive treatment.
Co-Authors ACHMAD FAUZI Alvita Dewi Hendra Budiawan Irma Wahyuni Rian Hidayatullah Tri Juli Edi Tarigan