A Case of Retroperitoneal Paraganglioma with Acute Abdomen

Abstract

A 54-year-old man was brought to our emergency department because of sudden abdominal pain accompanied by cold sweat. An abdominal computed tomography scan revealed the presence of a large retroperitoneal tumor with intratumoral hemorrhage, 11 cm in diameter, at the caudal side of the ascending portion of the duodenum and the left side of the aorta. Although we considered emergency surgery due to severe abdominal pain, after close inspection, we decided to proceed with elective surgery since a paraganglioma was suspected. The abdominal pain was relieved by narcotic analgesics. The tumor was diagnosed as a paraganglioma based on the high level of urinary catecholamine and MIBG uptake by the mass though ¹²³I-MIBG scintigraphy. After preoperative blood pressure control using α-adrenergic blockers, surgical resection was performed. During the operation, circulation dynamics were stable. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. Only few reports of paraganglioma with acute abdomen are available. It is important to diagnose paragangliomas preoperatively because emergency surgery without a previous diagnosis of paraganglioma is associated with high mortality.