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

• 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
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-017-0270-6

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.