• Tiantong Liu, Qiang Xu, Xi Zou, Liang Zhu, and Yupei Zhao.
• Department of General Surgery, Peking Union Medical College Hospital, School of Medicine, Tsinghua University, Beijing, China.
• Medicine (Baltimore). 2022 Oct 28; 101 (43): e31211e31211.

RationaleWe describe a case of insulinoma located extremely close to the accessory pancreatic duct (APD), but away from the main pancreatic duct (MPD). Previous studies showed insulinoma enucleation is a safe procedure for small benign tumors >3 mm distant from the MPD. However, in this case enucleation of the tumor led to unanticipated APD injury and grade B post-operative pancreatic fistula (POPF). We provide detailed records of clinical management and argue that enucleation of tumors near APD needs to be carefully weighed.Patient ConcernsThe patient experienced a sudden increase of abdominal drain fluid and prolonged drainage time after a regular insulinoma enucleation surgery.DiagnosisAPD damage during the enucleation.InterventionsDrain fluid amylase concentration were regularly recorded and prolonged somatostatin analogs were administered.OutcomesAmount of abdominal drain gradually decreased and the drain tube was removed on postoperative 37.LessonsBenign pancreatic tumor close to the APD need to be evaluated carefully and clinical evidence is warranted to affirm the necessity of placing a pancreatic duct stent before the surgery.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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