Ann Surg Treat Res.  2017 Sep;93(3):170-172. 10.4174/astr.2017.93.3.170.

Spontaneous ruptured pheochromocytoma: an unusual case report and literature review

• Jee YS

• KMID: 2398965
• DOI: http://doi.org/10.4174/astr.2017.93.3.170

Abstract

Ruptured pheochromocytoma is a rare disease. Its mortality rate is up to 31%-50%. Proper management of ruptured pheochromocytoma remains unclear. A 44-year-old male patient visited our Emergency Department and presented with abrupt onset of left flank pain. His blood pressure was 190/140 mmHg with purse rate of 130 beats/min. CT scan showed 8.1 × 5.6-cm-sized heterogeneously mass with rupture on the left retroperitoneal space and active bleeding. His symptom of abdominal pain was aggravated. Follow-up laboratory analysis revealed elevated WBC count and decreased hemoglobin 2 hours after admission. Emergency laparotomy was performed. We resected the ruptured left retroperitoneal mass and hemostasis. Pathologic exams revealed adrenal pheochromocytoma with rupture. Although our patient was alive, according to literature review, mortality rate of emergency operation without medical management is higher than elective operation after blood pressure control with either medical or interventional methods such as transcatheter arterial embolization.

Keyword

Spontaneous rupture; Pheochromocytoma

MeSH Terms

Abdominal Pain
Adult
Blood Pressure
Emergencies
Emergency Service, Hospital
Flank Pain
Follow-Up Studies
Hemorrhage
Hemostasis
Humans
Laparotomy
Male
Mortality
Pheochromocytoma*
Rare Diseases
Retroperitoneal Space
Rupture
Rupture, Spontaneous
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Abdomen CT reveals round heterogeneous retroperitoneal mass (8.1 cm × 5.6 cm) with hematoma aterosuperior left kidney (A) and active bleeding around tumor (B).

Reference

1. Lenders JW, Eisenhofer G, Mannelli M, Pacak K. Phaeochromocytoma. Lancet. 2005; 366:665–675.

2. Kobayashi T, Iwai A, Takahashi R, Ide Y, Nishizawa K, Mitsumori K. Spontaneous rupture of adrenal pheochromocytoma: review and analysis of prognostic factors. J Surg Oncol. 2005; 90:31–35.

3. Oh SH, Oh KJ, Kim KH, Kwon DD, Oh BR, Park YI. Spontaneous rupture of adrenal pheochromocytoma. Chonnam Med J. 2002; 38:285–287.

4. Kim EJ, Lim MJ, Bang BW, Park HJ, Hong SB, Nam MS, et al. A case of spontaneous rupture of adrenal pheochromocytoma. J Korean Endocr Soc. 2006; 21:424–427.

5. Cahill GF. Symphathoblast, Phochromoblast. Pensylvania Med J. 1994; 47:664–667.

6. Tanaka K, Noguchi S, Shuin T, Kinoshita Y, Kubota Y, Hosaka M. Spontaneous rupture of adrenal pheochromocytoma: a case report. J Urol. 1994; 151:120–121.

7. Ulchaker JC, Goldfarb DA, Bravo EL, Novick AC. Successful outcomes in pheochromocytoma surgery in the modern era. J Urol. 1999; 161:764–767.

8. Habib M, Tarazi I, Batta M. Arterial embolization for ruptured adrenal pheochromocytoma. Curr Oncol. 2010; 17:65–70.