Artificial Abdominal Hernia for the Treatment of Hepatomegaly in a Neonate With Stage 4s Neuroblastoma

Abstract

Surgical widening of the abdomen by a silastic pouch has been used very rarely in the management of critically ill infants with hepatomegaly due to neuroblastoma stage 4S. A female newborn baby was referred on the second day of life because of local compressive effects of a massive hepatomegaly, which lead to multiorgan failure. An artificial abdominal hernia was created on the third day of life using a silastic pouch. During the operation oxygenation and ventilation improved and urinary output returned. After chemotherapeutic reduction of hepatic metastases and primary tumor the pouch was successfully removed on day 57 without local complications. The child has survived for more than 1 year and is in complete remission. An artificial abdominal hernia should be considered more often in the critically ill neonate with stage 4S neuroblastoma and massive hepatomegaly.

Management of tumor rupture and abdominal compartment syndrome in an infant with bilateral high risk stage 4 neuroblastoma

“…The outcome related to survival of the neuroblastoma remains favorable even if laparostomy has been required in patients with rapidly growing tumors due to liver metastases resulting in an abdominal compartment syndrome (ACS). [9,10] Nevertheless, mortality from ACS ranges from 50% to 60% [11] , and early decompression by enterostomy has been described to improve outcome. [12] Another specific and in part lethal problem in newborns and young infants with NB may be disseminated intravascular coagulation.…”

2017 GPOH Guidelines for Diagnosis and Treatment of Patients with Neuroblastic Tumors

“…An intra-abdominal pressure > 10 mm Hg associated with new or worsening organ dysfunction is defined as abdominal compartment syndrome in children [88]. This condition requires the immediate start of chemotherapy, and if intra-abdominal hypertension develops or worsens despite chemotherapy, operative herniation of the abdominal wall must be considered [135]. Standard chemotherapy is the N4 cycle used in previous prospective German neuroblastoma protocols (▶Fig.…”

Successful treatment of MYCN amplified, progressive stage 4S neuroblastoma in a neonate with hepatic artery embolization in addition to multimodality treatment

“…The so‐called Philadelphia score can be applied to identify children who are particularly vulnerable to complications and therefore require early intervention 7. Case reports have described novel surgical interventions to provide relief from the compression by massive hepatomegaly 15,16. A recent case report by Weintraub et al described the successful management of a neonate with non‐ MYCN ‐amplified hepatic stage 4S NB by hepatic artery chemoembolization.…”