Surgical Management of Acute Appendicitis in a Patient with Diagnosed but “Unprepared” Pheochromocytoma: A Case Report

Pheochromocytoma is a rare tumor originating from the adrenal gland, characterized by the secretion of catecholamines. Due to the risk of hypertensive crises associated with catecholamine release, surgical procedures in pheochromocytoma patients are risky. In this case report, laparoscopic appendectomy for acute appendicitis in a patient who has pheochromocytoma will be presented. A 49-year-old female patient presented with abdominal pain. Physical examination showed guarding and rebound in the right lower quadrant. The patient, who had leukocytosis in the investigations, showed signs of acute appendicitis and a 5 cm right adrenal mass on the abdominal computed tomography. A previous abdominal magnetic resonance imaging by the endocrinology department six months ago revealed a 39x32 mm mass in the right adrenal gland and elevated urinary catecholamine levels. It was learned that the patient had not attended follow-up appointments during this period. The patient was consulted by endocrinology and an emergency laparoscopic appendectomy was performed. The patient, discharged on the 2nd day after surgery, did not experience any complications. The patient was referred to endocrinology, and preoperative preparations for pheochromocytoma surgery were initiated. In cases of emergency in patients diagnosed with pheochromocytoma emergency surgery can be performed with appropriate preoperative preparation.

Teþhis Edilmiþ Ancak “Hazýrlýksýz” Feokromasitoma Hastasýnda Akut Apandisitin Cerrahi Yönetimi: Bir Olgu Sunumu

Feokromasitoma adrenal bezde görülen nadir, katekolamin salgýlayan bir tümördür. Bu katekolamin salgýsýna baðlý hipertansif krizler görülebildiðinden feokromasitoma hastalarýnda cerrahi uygulamasý riskli olup acil cerrahi gerektiren durumlarda yaklaþýmýn nasýl olmasý gerektiði hakkýnda farklý görüþler mevcuttur. Bu vaka sunumunda feokromasitoma tanýsý almýþ olan bir hastada akut apandisit nedeniyle laparoskopik apendektomi uygulanmasý sunulacaktýr. Kýrk dokuz yaþýnda kadýn hasta 1 günlük karýn aðrýsý ile acile baþvurdu. Yapýlan tetkiklerinde lökositozu olan hastanýn çekilen batýn bilgisayarlý tomografisinde akut apandisit lehine bulgular ve 5 cm’lik sað adrenal kitle saptandý. Hastanýn 6 ay önce endokrinoloji tarafýndan yapýlan batýn manyetik rezonans görüntülemesinde sað adrenal bezde 39x32 mm’lik kitle olduðu ve üriner katekolamin tetkiklerinde yükseklik saptandýðý görüldü. Hastanýn bu süreçte takiplerine gitmediði öðrenildi. Hastaya acil þartlarda laparoskopik apendektomi yapýldý. Ameliyat sonrasý 2. Gün taburcu edilen hastada komplikasyon geliþmedi. Endokrinolojiye yönlendirilen hastanýn feokromasitoma cerrahisi için preoperatif hazýrlýklarý baþlatýldý. Feokromasitoma tanýsý olan hastalarda geliþen acil durumlarda hipertansif kriz riski olmakla birlikte gereðinde uygun preoperatif hazýrlýkla acil cerrahi uygulanabilir. Feokromasitoma tanýsý alan hastalarýn cerrahi tedavisinin hýzlýca yapýlmasý bu süreçte geliþebilecek acil durum riskini azaltacaktýr. (SETB-2024-02-037)