Enterocolitis with peritonitis in a child with pheochromocytoma
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A rare case of catecholamine-induced enterocolitis occurred in an 8-year-old boy with pheochromocytoma. The condition presented as severe abdominal pain and bleeding, resolving after tumor removal and surgical intervention.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Surgical Oncology
Background:
- Pheochromocytoma, a rare adrenal tumor, can cause severe hypertension.
- Hypertensive crises associated with pheochromocytoma can precipitate gastrointestinal complications.
- Enterocolitis is an inflammation of the small and large intestines.
Observation:
- An 8-year-old boy presented with a month of hypertension, followed by acute abdominal pain, rectal bleeding, peritonitis, and shock.
- Laparotomy revealed diffuse inflammation and edema of the colon and terminal ileum, with necrotic areas in the cecum.
- A 5 cm right adrenal pheochromocytoma with a hemorrhagic center was surgically removed.
Findings:
- The patient experienced sudden onset of severe gastrointestinal symptoms, including colitis and necrosis, preceding surgical intervention.
- Surgical management involved a diverting loop ileostomy and inversion of necrotic cecal areas.
- Postoperative recovery showed normalization of blood pressure and improvement of colitis.
Implications:
- This case highlights pheochromocytoma as a potential cause of catecholamine-induced enterocolitis.
- The findings suggest that a hypotensive episode can trigger the progression from colitis to necrosis in pheochromocytoma patients.
- Early diagnosis and management of pheochromocytoma are crucial to prevent severe gastrointestinal complications.
Abstract:
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.