Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature

Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though,...

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Bibliographic Details
Published in:BMC surgery 2017-06, Vol.17 (1), p.74-74, Article 74
Main Authors: Liu, Hui-Pu, Chang, Wen-Yen, Chien, Shan-Tao, Hsu, Chin-Wen, Wu, Yu-Chiuan, Kung, Wen-Ching, Su, Chun-Min, Liu, Ping-Hung
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Pain - etiology
Adipose tissue
Adrenal Gland Neoplasms - diagnosis
Adrenal Gland Neoplasms - surgery
Adrenal glands
Adrenal myelolipoma
Adult
Attenuation
Benign
Biopsy
Bleeding
Calcification
Case Report
Case studies
CAT scans
Complications and side effects
Computed tomography
Diagnosis
Fat-content mass
Hemoperitoneum - etiology
Hemorrhage
Hemorrhagic shock
Humans
Kidneys
Laparotomy - methods
Lipoma
Liposarcoma
Literature reviews
Male
Management
Mesenchyme
Myelolipoma - diagnosis
Pain
Retroperitoneum
Risk factors
Shock, Hemorrhagic - etiology
Shock, Hemorrhagic - surgery
Teratoma
Tumors
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Summary:Adrenal myelolipoma is an uncommon, benign, and hormonally non-functioning tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of tumor was done. Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.
ISSN:1471-2482
1471-2482
DOI:10.1186/s12893-017-0270-6