Retroperitoneal Mass at Medicover

A 55-year-old female came to Medicover Kakinada. with gross abdominal distension and breathlessness due to mechanical effect of the distended abdomen. On enquiring further, she was diagnosed to have large abdominal mass of inconclusive origin 4 years ago and she had history of recurrent Supraventricular Tachycardia episodes and was on treatment with medicines.

In view of old age and frailness, very large abdominal complex cystic mass of inconclusive origin, cardiac arrythmia - surgical treatment was deferred by most hospitals. Patient and her attendants lost hope of cure and went for alternative medicine but tumor size increased further in size, caused mechanical pressure effects and nutritionally deprived her.

She was admitted and optimised nutritionally. Once patient got better symptomatically, she was reviewed again with all her old reports and imaging data. At the request of patient’s attendants, we proceeded with re-evaluation of mass for chance of operability. She was nutritionally compromised with severe malnutrition due to mechanical effects of tumor and tumor cachexia.

CECT abdomen with proper protocol performed, suggestive of large cystic mass of about 33x25 cm size which was extending from left dome of diaphragm to pelvis compressing all near-by structures and identified to be arising from distal body of pancreas probably mucinous cystadenoma of pancreas.

It was further confirmed by CA 19.9 - >1000.

After thorough evaluation – patient’s attendants were counselled about the possibility of resection. Explained very high risk of the procedure and the possible complications that can arise from such major surgeries. Patient attendants gave consent to proceed with surgery.

Patient was optimised

After one week she was posted for surgery after getting all the clearances and arranging adequate blood products.

Exploration done - it was a large complex cystic mass replacing body of pancreas with compression of all surrounding organs with infiltration into splenic flexure mesocolon.

Radical Distal Pancreatico splenectomy done along with large mass and splenic flexure of colon resected and colo-colic anastomosis done. (In view of possibility of malignancy)

Patient tolerated procedure well with no significant haemodynamic changes and needed only one packed RBC transfusion intraoperatively.

Patient shifted to ICU with minimal ionotropic supports and maintained for one day. She recovered well and was on mask ventilation with 2litres of oxygen for two days post-op. She was shifted to room on post-op day-3, started on oral diet. She was started on deep vein thrombosis prophylaxis and permissive spirometry post operatively.

On post-op day 5, she developed SVT with HR> 170 with hypotension- shifted to ICU and started on minimal supports and amiodarone infusion (under complete supervision of cardiology team)- recovered in few hours and her cardiac medicines were optimised.

Patient discharged on post-op day 8 in fully ambulating, orally tolerating condition.

This was one of the major procedures performed at Medicover, Kakinada. No reference of removal of such large pancreatic mass (33x25 cm) was found till date in medical literature.

Contributors

Dr. Venkanna Babu Akula

Consultant Surgical, Gastroenterologist

News Letter

Medicover Hospitals Impact Newsletter November 2022