Department of General Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Türkiye.
Department of Urology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Nov;28(11):1650-1654. doi: 10.14744/tjtes.2021.68792.
Acute abdomen is a serious condition frequently encountered in the emergency departments (ED). There are various etiologies causing acute abdomen, most common being acute appendicitis; however, there are rare causes of acute abdomen as well and one should keep them in mind while handling a patient with unusual clinical features. We herein present a 26-year-old male, with no past medical or surgical history, presenting with acute abdominal pain and distension to the ED. He was found to have a large vascular retroperitoneal mass on computed tomography which had invaded and perforated the duodenum thus causing the acute presentation. Repair of the duodenal perforation and sampling of the mass were performed in terms of surgical management. Pathology results revealed the mass originating from a burned out testis yolk sac tumor with embryonal carcinoma component. Although the original tumor had regressed at the testis, its metastasis at the retroperitoneal area had caused the clinical condition. This entity is described as the retroperitoneal metastasis of a burned-out testicular tumor. Few cases presenting with gastrointestinal bleeding secondary to invasion of the retroperitoneal metastasis have been reported. However, this is the first case in the literature presenting with duodenal perforation and acute abdomen. Sampling of the retroperitoneal tumor for histopathological diagnosis during the immediate surgical intervention facilitates the diagnostic management in these cases. Although scrotal examination combined with testis tumor marker assessments is essential for optimal patient management, the possibility of a burned-out testicular tumor with normal scrotal examination should always be kept in mind.
急性腹痛是急诊科常见的严重病症。引起急性腹痛的病因有很多，最常见的是急性阑尾炎；然而，也有一些罕见的病因，在处理具有不典型临床特征的患者时应牢记这些病因。本文报告了 1 例 26 岁男性，无既往病史和手术史，因急性腹痛和腹胀至急诊科就诊。腹部 CT 检查发现患者腹膜后有一巨大血管源性肿块，肿块已侵犯并穿透十二指肠，导致患者出现上述急性症状。根据外科治疗原则，对患者行十二指肠穿孔修补术和肿块取样术。病理结果显示肿块来源于已退化的睾丸卵黄囊瘤，伴胚胎癌成分。尽管原发肿瘤已在睾丸处消退，但肿瘤转移至腹膜后区域导致了目前的临床症状。这种情况被描述为已退化睾丸肿瘤的腹膜后转移。有几例报道因腹膜后转移侵犯导致胃肠道出血的病例，但本文是首例因十二指肠穿孔和急性腹痛而就诊的病例。在紧急外科干预期间对腹膜后肿瘤进行组织病理学诊断取样有助于此类病例的诊断管理。虽然进行阴囊检查并结合睾丸肿瘤标志物评估对患者的最佳管理至关重要，但对于阴囊检查正常的已退化睾丸肿瘤仍应保持警惕。
