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SAGES Case of the Month: Presentation
Submitted by Eren Berber, MD

Laparoscopic Resection of Abdominal Paragangliomas

Background            

  • Paragangliomas are rare neoplasms derived from neural crest cells
  • They may arise in paraganglia anywhere along the autonomic chain
    • Head/neck (3%)
    • Thorax (12%)
    • Abdomen (85%)
  • There is a paucity of experience with laparoscopic resection in the literature
  • Here we present a case of laparoscopic resection of an abdominal paraganglioma

Clinical Case

  • 29yo female with history of IDDM and HTN
  • Hospitalized with progressive shortness of breath, weight gain, and tachycardia
  • Found to be profoundly hypertensive (220/150) in florid heart failure (EF 25%)
  • Diagnosis of pheochromocytoma was suspected
  • CT abdomen obtained

Axial View of Mass Between Distal IVC and Aorta

Paraganglioma at Organ of Zuckerkandl

Coronal View of Mass Between Distal IVC and Aorta at Their Bifurcations 

Coronal image of mass between distal IVC and aorta at their bifurcations

Sagital View of Mass Adjacent to Distal Aorta

Sagital view of mass near distal aorta

Sagital View of Mass Adjacent to Distal IVC

Sagital view of mass near distal IVC

  • Serum and urine metanephrines elevated
  • Alpha and beta-blockade initiated
  • Taken to the operating room for laparoscopic resection

(Have short intraoperative video to insert here)

Hospital Course

  • No introperative complications
  • EBL 30cc's
  • Discharged POD # 3

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