2022 Volume 59 Issue 2 Pages 197-201
Although stage 4S neuroblastoma has a favorable prognosis in most patients, a few patients with massive hepatomegaly require critical management. Here we describe the case of a two-month-old girl with stage 4S neuroblastoma. She already had symptoms of lower leg edema, respiratory distress resulting from abdominal compartment syndrome, and coagulopathy at the initial visit. Abdominal radiotherapy that consisted of a fraction dose of 1.5 Gy for three days was initiated immediately after liver biopsy. On day 3 of radiotherapy, she developed respiratory failure, acute renal failure, and liver failure due to tumor lysis syndrome in addition to abdominal compartment syndrome. Hence, extracorporeal membrane oxygenation (ECMO) and continuous hemodiafiltration (CHDF) were initiated to stabilize her condition until the effect of radiation improved her abdominal compartment syndrome. Her respiratory status gradually improved and ECMO was successfully discontinued; CHDF was also discontinued after the recovery of kidney function. We conclude that radiotherapy is effective for abdominal compartment syndrome in stage 4S neuroblastoma patients, and ECMO can be an effective rescue choice in a patient with respiratory failure.
