A patient with organic hyperinsulinism is described. A malignant islet cell tumor in the head of the pancreas was found and removed. Because of persistent hypoglycemia, subtotal pancreatectomy was performed, but no additional tumor was found. A year later, total pancreatectomy, duodenectomy and resection of part of the stomach and jejunum were performed with failure again to find a tumor. Only by means of selective arteriography of the celiac artery were two tumors discovered in the right lobe of the liver. These were removed by resection of the lobe of the liver and histologically confirmed as metastatic islet cell tumor. After this operation there were no further hypoglycemic attacks but persistent diabetes ensued. The resection of the metastatic islet cell tumor took place three and one-half years after the initial hypoglycemic attacks. The patient is symptom-free four years after removal of the metastases.

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