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Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy
Published on: May 5, 2023
973
Cephalic Pancreaticoduodenectomy With Right Nephrectomy for Traumatic Ruptured Wilms Tumor.
Elily D Apumayta1, Nestor Sanchez2, Eduardo Cayo3
1Department of Abdominal Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, PER.
Cureus
|June 30, 2025
Summary
Preoperative Wilms tumor rupture in children can necessitate emergency surgery. This case highlights a multivisceral resection for a hemodynamically unstable patient with a ruptured Wilms tumor and duodenal injury.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Abdominal Trauma Management
Background:
- Wilms tumor is the most common pediatric extracranial solid tumor in Peru.
- Preoperative tumor rupture is an uncommon but serious complication.
- Management varies based on rupture severity and hemodynamic stability.
Observation:
- A 3-year-old male presented with abdominal trauma, severe pain, and distension.
- The patient had a right Wilms tumor with venous extension, lymph node, and pulmonary metastases.
- Initial medical management failed, leading to persistent hemodynamic decompensation.
Findings:
- Emergency laparotomy revealed a preoperative Wilms tumor rupture with a Grade V duodenal injury.
- A multivisceral resection was performed, including nephrectomy, thrombectomy, lymph node dissection, and pancreaticoduodenectomy.
- Oncologic principles were maintained despite the emergency setting.
Implications:
- Clinical and radiological evaluation is crucial for managing tumor rupture.
- Emergency surgery is indicated for life-threatening hemodynamic decompensation unresponsive to medical treatment.
- Multivisceral resection may be necessary for Wilms tumor rupture with associated injuries, prioritizing oncologic outcomes and patient safety.
