Sugai Yu, Yamoto Masaya, Obayashi Juma, Tsukui Takafumi, Nomura Akiyoshi, Miyake Hiromu, Fukumoto Koji, Kim Sung-Hae, Sato Daijiro, Iwafuchi Hideto
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-Ku, Shizuoka, 420-8660, Japan.
Department of Cardiology, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-Ku, Shizuoka, 420-8660, Japan.
Surg Case Rep. 2024 Aug 20;10(1):192. doi: 10.1186/s40792-024-01992-w.
Supine hypotension syndrome (SHS) has been reported to occur due to compression by a giant tumor such as ovarian tumor. We herein report a case of retroperitoneal ganglioneuroma with SHS treated with laparoscopic resection.
The patient was an 11-year-old male with right-sided abdominal pain. He had a pale complexion and tachycardia while falling asleep. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a giant mass lesion (60 × 35 mm) with compression of the inferior vena cava (IVC) and duodenum ventrally and the right kidney caudally. The IVC was flattened by mass compression. Abdominal ultrasonography (US) revealed narrowing of the IVC due to the mass and accelerated blood flow after IVC stenosis in the supine and left lateral recumbent position. His pale complexion and tachycardia while falling asleep was thought to be due to decreased venous return caused by the tumor compressing the IVC, resulting hypotension. 123I-MIBG scintigraphy revealed no abnormal findings. Tumor markers were normal. He was diagnosed with SHS due to a right adrenal gland tumor. The tumor compressed the IVC from the dorsal side, and hemostasis was expected to be difficult during bleeding. Therefore, a guidewire was inserted from the right femoral vein into the IVC for emergency balloon insertion during bleeding. A laparoscopic tumor resection was performed. A histopathological examination confirmed the diagnosis of primary retroperitoneal ganglioneuroma.
The treatment of symptomatic retroperitoneal tumors requires a multidisciplinary approach.
据报道，仰卧位低血压综合征（SHS）可因巨大肿瘤（如卵巢肿瘤）压迫所致。我们在此报告一例经腹腔镜切除治疗的伴有SHS的腹膜后神经节细胞瘤病例。
患者为一名11岁男性，有右侧腹痛症状。入睡时面色苍白、心率加快。计算机断层扫描（CT）和磁共振成像（MRI）显示一个巨大肿块（60×35mm），腹侧压迫下腔静脉（IVC）和十二指肠，尾侧压迫右肾。IVC因肿块压迫而变扁。腹部超声（US）显示IVC因肿块而变窄，在仰卧位和左侧卧位时IVC狭窄后血流加速。他入睡时面色苍白和心率加快被认为是由于肿瘤压迫IVC导致静脉回流减少，从而引起低血压。123I-MIBG闪烁显像未发现异常。肿瘤标志物正常。他被诊断为因右肾上腺肿瘤导致的SHS。肿瘤从背侧压迫IVC，预计出血时止血困难。因此，从右股静脉插入导丝至IVC，以便在出血时紧急插入球囊。进行了腹腔镜肿瘤切除术。组织病理学检查确诊为原发性腹膜后神经节细胞瘤。
有症状的腹膜后肿瘤的治疗需要多学科方法。
