Unexpected Hemodynamic Instability Following Suspected Tumor Content Leakage During Laparoscopic Resection of...

Pheochromocytoma resection is frequently associated with marked perioperative hemodynamic instability due to excessive catecholamine release. We report a case characterized by an unusual sequence of abrupt hypotension during tumor manipulation followed by sustained postoperative hypertension and tachycardia. A 51-year-old man underwent laparoscopic adrenalectomy for a large adrenal pheochromocytoma after appropriate preoperative α- and β-adrenergic blockade and volume optimization. Following pneumoperitoneum formation, severe hypertension developed despite intensified anesthetic management. During tumor handling, blood pressure suddenly declined, necessitating vasopressor support. Based on intraoperative findings, leakage of catecholamine-rich tumour contents was suspected, leading to a transient reduction in systemic catecholamine inflow. After tumor resection, hypertension and tachycardia persisted for several hours postoperatively, requiring β-blocker therapy before gradually resolving. This atypical hemodynamic pattern suggests that leaked catecholamines may have been absorbed from the peritoneal cavity, resulting in prolonged sympathetic activation. This case highlights that intraoperative tumor content leakage can cause unpredictable and paradoxical hemodynamic responses during pheochromocytoma surgery. Awareness of this mechanism and close communication between surgeons and anesthesiologists are essential for prompt recognition and safe perioperative management.