From the Guidelines
The gastrinoma triangle is defined by three anatomical borders: the junction of the cystic duct and common bile duct superiorly, the junction of the second and third portions of the duodenum inferiorly, and the junction of the neck and body of the pancreas medially. This definition is based on the most recent and highest quality studies available, including those from the Journal of the National Comprehensive Cancer Network 1. The gastrinoma triangle is a critical landmark in the upper abdomen, containing approximately 70-90% of gastrinomas, which are neuroendocrine tumors that secrete excessive gastrin hormone, leading to Zollinger-Ellison syndrome characterized by severe peptic ulcer disease, diarrhea, and abdominal pain 1. Understanding the precise anatomical boundaries of the gastrinoma triangle is essential for surgeons when exploring for these tumors during operations, as they can be small and difficult to locate, and this knowledge guides the surgeon to the most likely locations where these tumors may be found, thereby improving detection rates and surgical outcomes. Key points to consider in the management of gastrinomas include:
- The role of imaging studies, such as multiphasic CT/MRI scans, in localizing the tumor and confirming the diagnosis 1.
- The importance of measuring basal and stimulated gastrin levels, while considering the potential impact of proton pump inhibitors on these measurements 1.
- The value of somatostatin scintigraphy, EUS, and chromogranin A levels in the diagnostic workup of suspected gastrinomas 1. Overall, the gastrinoma triangle serves as a vital anatomical reference point in the diagnosis and surgical management of gastrinomas, with its boundaries playing a crucial role in guiding surgical exploration and improving patient outcomes.
From the Research
Borders of the Gastrinoma Triangle
The borders of the gastrinoma triangle are defined by several key anatomical landmarks.
- The junction of the cystic and common bile ducts superiorly 2, 3
- The junction of the second and third portions of the duodenum inferiorly 2, 3
- The junction of the neck and body of the pancreas medially 2, or alternatively, the pancreatic head 4 Other studies also describe the borders in relation to the porta hepatis and the duodenal sweep 4.
Anatomical Significance
The gastrinoma triangle is significant because it is the area where occult gastrinomas are most likely to be found 2.
- Gastrinomas are often located within this triangle or in the adjacent lymph nodes 5
- The triangle is also the region where primary nodal gastrinomas can occur 3
Clinical Implications
Understanding the borders of the gastrinoma triangle is crucial for the diagnosis and treatment of Zollinger-Ellison syndrome and gastrinomas.