Malignant pheochromocytoma associated with pseudo-obstruction of the colon

Abstract

Effective treatment has not yet been established for intestinal pseudo-obstruction, a rare complication of malignant pheochromocytoma. We report the case of a 41-year-old man who presented with malignant pheochromocytoma associated with pseudo-obstruction of the colon. His serum catecholamine level was markedly elevated, and his large intestine was distended with gas and lodged stool. Laxatives and enemas were not effective in relieving his symptoms. We subsequently performed an ileostomy, after which the patient had good bowel movement and was able to resume oral food intake.

Perioperative anesthetic management of intestinal pseudo-obstruction as a complication of pheochromocytoma

“…2 Operating Rooms, Kyushu University Hospital, Fukuoka, Japan. 3 Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.…”

“…Gastrointestinal pseudo-obstruction, or paralytic ileus, can be caused by pheochromocytoma with hypersecretion of catecholamines, which act on α 2 -adrenergic receptors of intestinal smooth muscle cells to decrease intestinal peristalsis [1,2]. Although several cases have been reported, the literature contains few descriptions of perioperative anesthetic management for these patients [3][4][5][6]. Because of the absence of any obstructive structural lesions in the intestinal tract, we presumed that a strategy for promoting intestinal peristalsis postoperatively would be advantageous.…”

Review article: the assessment and management of chronic severe gastrointestinal dysmotility in adults

“…Other endocrine disorders have been associated with severe dysmotility including acromegaly, thyroid disease, phaeochromocytoma and somatostatinoma…”

A rare and life-threatening cause of pseudo-obstruction in two surgical patients

“…Between 10–20% of cases occur as a consequence of specific germ-line mutations which are associated with several recognised conditions (including multiple endocrine neoplasia type 2, Von Hippel Lindau syndrome and Neurofibromatosis). Ileus or pseudo-obstruction is an unusual but recognised presentation of phaeochromocytoma 2–4. Typical symptoms which may be revealed in the history of such patients include anxiety attacks, headache, palpitations and heavy sweating and the patient commonly has hypertension.…”