Postoperative acute kidney failure and incision skin necrosis caused by a giant retroperitoneal paraganglioma

0
0
0

Postoperative acute kidney failure and incision skin necrosis caused by a giant retroperitoneal paraganglioma

Paragangliomas—rare neuroendocrine tumors that typically grow near the adrenal glands—are especially unusual when they develop in the retroperitoneum, the space behind the stomach and intestines. A 2019 case report from Chinese Medical Journal details how a giant retroperitoneal paraganglioma led to unexpected postoperative complications, shedding light on the links between rare tumors and systemic health issues.

The Patient’s Story

A 68-year-old man visited Hangzhou First People’s Hospital in China with a 1-year history of foamy urine—a classic sign of proteinuria (excess protein in the urine). His symptoms worsened in the three weeks before admission. During an exam, doctors found a fixed, giant abdominal mass measuring 22cm × 18cm. Lab tests confirmed severe proteinuria (3.0g per 24 hours) and hypoalbuminemia (low blood albumin: 29g/L, compared to the normal 40–55g/L). Inflammatory and tumor markers were normal.

A contrast-enhanced CT scan revealed the mass was a cystic solid tumor stretching from the right upper abdomen to the pelvis. Its rich blood supply made the tumor’s surface “light up” on the scan—an important clue about its vascularity.

Surgery and Complications

Surgical removal was the only curative option: Retroperitoneal paragangliomas are resistant to radiation and chemotherapy, as noted in prior studies (Oncol Lett, 2017). But the operation was challenging: Decompressing the inferior vena cava (a major vein) caused temporary low blood pressure, and the tumor’s vascular capsule led to minor bleeding.

The day after surgery, the man faced two serious complications:

  1. Acute kidney failure (AKI): He had high serum creatinine (a kidney function marker) and severe oliguria (very little urine).
  2. Incision skin necrosis: Partial tissue death around the surgical cut.

Treatment and Recovery

The AKI was treated with hemodialysis three times a week for one month—after which his kidney function fully recovered. The necrotic skin was treated with topical alprostadil, a vasodilator that improves blood flow. Healthy skin replaced the necrotic area in two weeks.

Follow-Up and Key Insights

At the 3-month follow-up, the man’s proteinuria had resolved, and his albumin level was nearly normal. This confirmed the tumor was the root cause of his proteinuria and low albumin. Unlike most paragangliomas (which produce catecholamines that raise blood pressure), this one was “nonfunctional”—explaining his normal blood pressure.

By 28 months, the man was disease-free and satisfied with his health. The case offers critical takeaways:

  • Tumor-related proteinuria: The mass directly caused the man’s foamy urine and low albumin.
  • AKI risk: Preoperative proteinuria may increase the chance of postoperative kidney injury, as supported by a 2018 JAMA Surg study linking the two.
  • Skin necrosis cause: The giant tumor increased skin tension and formed abnormal blood vessels to the abdominal wall. Removing the tumor suddenly cut off this blood supply, leading to rare ischemic necrosis.

About the Study

This case was reported by Zhong Jia, Jia-Qing Huang, and Shi-Jie Li from the Department of Hepatobiliary Surgery at Affiliated Hangzhou First People’s Hospital, part of Zhejiang University School of Medicine and Zhejiang Chinese Medical University. The patient gave informed consent for publication, with steps taken to protect his identity.

References

  1. Asa SL, Ezzat S, Mete O. The diagnosis and clinical significance of paragangliomas in unusual locations. J Clin Med 2018;7:1–15. doi:10.3390/jcm7090280
  2. Xiao KJ, Xiang WZ, Xiu LW, et al. Diagnosis and surgical treatment of retroperitoneal paraganglioma: a single-institution experience of 34 cases. Oncol Lett 2017;14:2268–2280. doi:10.3892/ol.2017.6468
  3. Wu GC, Wang KL, Zhang ZT. Gangliocytic paraganglioma of the duodenum: a case report. Chin Med J 2012;125:388–389. doi:10.3760/cma.j.issn.0366-6999.2012.02.039
  4. Wahl TS, Graham LA, Morris MS, et al. Association between preoperative proteinuria and postoperative acute kidney injury and readmission. JAMA Surg 2018;153:E1–E10. doi:10.1001/jamasurg.2018.2009

Original study published in Chinese Medical Journal 2019;132(6):733–734. doi:10.1097/CM9.0000000000000113

Was this helpful?

0 / 0