Enterocolitis with peritonitis in a child with pheochromocytoma

An 8-year-old boy presented at UCLA Hospital with a one month history of hypertension prior to suffering a sudden onset of acute abdominal pain, rectal bleeding, peritonitis, and shock. Sigmoidoscopy showed diffuse mucosal friability. At laparotomy, inflammation and edema of the entire colon and terminal ileum were detected with two necrotic areas on the cecum. A 5 cm right adrenal pheochromocytoma with a hemorrhagic center was removed and a diverting loop ileostomy with inversion of the necrotic cecal areas was performed. Postoperatively, the blood pressure gradually returned to normal, and the colitis improved. Serum calcium and T3 T4 levels were normal. Review of the literature demonstrates that in patients with pheochromocytoma, progression from colitis to necrosis can be precipitated by a hypotensive episode. This patient suggests an example of catecholamine induced enterocolitis.