Abstract
Total gastrectomy has been advocated by Zollinger and Craig (ig6oa and b) in the treatment of these cases, whether or not a resectable pancreatic tumour is present. This procedure was not carried out in our case, because of the patient's poor general condition, the magnitude of the surgery already undertaken, and the presence of the great dilated veins in the fundal and hiatal regions. However, a radical subtotal gastrectomy was achieved. He has remained well for two years, having now a high platelet count but no evidence of polycythaemia. The tumour being malignant, it is feared that further ulceration may occur, as metastases develop. It is proposed to estimate the night acid secretion, and to test for frecal occult blood at intervals, in an effort to anticipate further ulceration and its complications. Summary A case of the Zollinger-Ellison syndrome is described. A large non-beta-cell carcinoma arising in the tail of the pancreas apparently caused a 'back pressure' effect on the spleen. The resulting splenomegaly and venous engorgement made detection of the tumour difficult. The clinical problem was further complicated by an abnormal blood picture initially suggestive of polycyth:emia vera.
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