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Case Reports
. 2018 Aug;18(4):345-347.
doi: 10.7861/clinmedicine.18-4-345.

Lesson of the month 2: Blunt abdominal trauma: atypical presentation of phaeochromocytoma

Sarah Faloon  1 , Hema Venkataraman  2 , Kassiani Skordilis  2 , Ewen A Griffiths  2 , Neil Jl Gittoes  2 , Zaki K Hassan-Smith  2   3 , John Ayuk  2
Affiliations
Case Reports

Lesson of the month 2: Blunt abdominal trauma: atypical presentation of phaeochromocytoma

Sarah Faloon et al. Clin Med (Lond). 2018 Aug.

Abstract

A 26-year-old man presented following blunt abdominal trauma to a regional major trauma centre for emergency embolisation of a retroperitoneal bleed from a presumed renal laceration. Imaging had also revealed a large right suprarenal mass. Embolisation resulted in a hypertensive crisis raising the suspicion of a metabolically active adrenal tumour. The course was further complicated by the development of ischaemic bowel requiring emergency laparotomy. Intraoperatively he became haemodynamically unstable from an actively haemorrhaging lesion. Emergency laparotomy and adrenalectomy was performed as a life-saving procedure. Histology confirmed a phaeochromocytoma. The patient made a gradual recovery and was discharged home with no sequelae. Definitive management of phaeochromocytoma is surgical resection which requires prolonged preoperative optimisation with alpha receptor blockers to adequately control blood pressure and prevent hypertensive crises. Parenteral alpha receptor blockers, such as phentolamine, are optimal treatment for intraoperative hypertensive emergencies, yet they are currently not available in the UK.

Keywords: Phaeochromocytoma; abdominal trauma; ­interventional radiology.

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Figures

Fig 1.
Fig 1.
CT abdomen showing large residual haematoma. CT = computed tomography
Fig 2.
Fig 2.
Colonic section showing necrosis of mucosa.
Fig 3.
Fig 3.
Ruptured adrenal tumour.
Fig 4.
Fig 4.
Images of the phaeochromocytoma. (a) Chromogranin staining. (b) Haematoxylin and Eosin section. (c) SDHB expression.
See this image and copyright information in PMC

Comment in

References

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