Feocromocitoma quístico gigante: reporte de un caso / Pheochromocytoma giant cystic: a case report

El feocromocitoma quístico gigante es tumor adrenal raro en el que predomina el curso asintomático; por lo que muchos de los casos no son diagnosticados hasta el momento de la cirugía. La simple movilización del tumor se asocia con el paso a la sangre de grandes cantidades de catecolaminas y a una elevada morbimortalidad.; por esta razón la cirugía per se y su manejo perioperatorio constituyen un enorme desafío. En este artículo se presenta el caso de un feocromocitoma gigante maligno (35 cm) que ocupaba todo el hemiabdomen derecho. Aun con el diagnóstico preoperatorio de feocromocitoma, el bloqueo farmacológico preoperatorio y las medidas intraoperatorias, el paciente falleció poco antes de que finalizara la cirugía.

The giant cystic pheochromocytoma is a rare adrenal tumor in the predominantly asymptomatic course; so many cases are not diagnosed until the time of surgery. The simple mobilization of the tumor is associated with the passage to the blood of large amounts of catecholamines and high morbidity and mortality. So the surgery itself and perioperative management are a huge challenge. This article describes the case of a malignant giant pheochromocytoma (35 cm) which occupied the entire right abdomen. Even with the preoperative diagnosis of pheochromocytoma, pharmacological blockade preoperative and intraoperative measures, the patient died shortly before the end of surgery.

[Pheochromocytoma giant cystic: a case report]. / Feocromocitoma quístico gigante: reporte de un caso.

The giant cystic pheochromocytoma is a rare adrenal tumor in the predominantly asymptomatic course; so many cases are not diagnosed until the time of surgery. The simple mobilization of the tumor is associated with the passage to the blood of large amounts of catecholamines and high morbidity and mortality. So the surgery itself and perioperative management are a huge challenge. This article describes the case of a malignant giant pheochromocytoma (35 cm) which occupied the entire right abdomen. Even with the preoperative diagnosis of pheochromocytoma, pharmacological blockade preoperative and intraoperative measures, the patient died shortly before the end of surgery.

Disfonía como presentación precoz de perforación colónica / Dysphonia as early presentation symptom in colonic perforation

Se presentan dos casos clínicos, en los que la sintomatología principal fueron disfonía y enfisema subcutáneo cervical, encontrándose neumomediastino, neumoperitoneo y retroneumoperitoneo causados por perforación colónica, ambos pacientes fueron intervenidos en el Hospital Campo Arañuelo de Navalmoral de la Mata. Rara vez la disfonía y el enfisema subcutáneo cervical pueden ser la primera manifestación de una perforación oculta del tracto gastrointestinal o de otro proceso retroperitoneal. El enfisema subcutáneo causado por perforaciones colónicas no traumáticas es extremadamente raro, pero debe considerarse cuando el origen del enfisema subcutáneo no ha sido encontrado. Los enfisemas subcutáneos no iatrogénicos son escasos en la bibliografía, y constituyen signos de diverticulitis sigmoidea perforada o carcinoma asociado como casos mas frecuentes. Generalmente el pronóstico de estos enfermos es malo, siendo el enfisema subcutáneo un signo poco frecuente pero ominoso de perforación de víscera hueca abdominal. Ambos pacientes fueron intervenidos y requirieron tratamiento antibiótico de amplio espectro, uno de ellos necesito ser trasladado por necesidad de Unidad de Cuidados Intensivos para soporte ventilatorio, siendo posteriormente reintervenido en nuestro hospital por un absceso residual y dado de alta.

We report two cases with similar main complaints: dysphonia and subcutaneous cervical emphysema. After diagnosis procedures we identified pneumomediastinum, pneumoperitoneum and pneumoretroperitoneum caused by colonic perforation. Both patients underwent surgical treatment at Hospital Campo Arañuelo, Navalmoral de la Mata. Dysphonia and subcutaneous cervical emphysema are infrequent symptoms of presentation for occult gastrointestinal tract perforation or any retroperitoneal condition. Subcutaneous emphysema due to colonic perforation is extremely uncommon but it must to be considerateas a cause when its etiology remains unknown. Non iatrogenic subcutaneous emphysema is very rare in publications and is mostly associated with perforated sigmoid diverticulitis or carcinoma and the prognosis is poor Both patients underwent surgical treatment and also a wide spectrum antibiotic course. One of them needed respiratory support in the intensive care unit, and, in the outcome, he required a second surgical procedure to evacuate a residual abscess before discharge.

[Dysphonia as early presentation symptom in colonic perforation]. / Disfonía como Presentación Precoz de Perforación Colonica.

We report two cases with similar main complaints: dysphonia and subcutaneous cervical emphysema. After diagnosis procedures we identified pneumomediastinum, pneumoperitoneum and pneumoretroperitoneum caused by colonic perforation. Both patients underwent surgical treatment at Hospital Campo Arañuelo, Navalmoral de la Mata. Dysphonia and subcutaneous cervical emphysema are infrequent symptoms of presentation for occult gastrointestinal tract perforation or any retroperitoneal condition. Subcutaneous emphysema due to colonic perforation is extremely uncommon but it must to be considerate as a cause when its etiology remains unknown. Non iatrogenic subcutaneous emphysema is very rare in publications and is mostly associated with perforated sigmoid diverticulitis or carcinoma and the prognosis is poor Both patients underwent surgical treatment and also a wide spectrum antibiotic course. One of them needed respiratory support in the intensive care unit, and, in the outcome, he required a second surgical procedure to evacuate a residual abscess before discharge.