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

Abstract

BackgroundAdrenal 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.Case presentationHerein 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.ConclusionAdrenal 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.

Adrenal myelolipoma: a comprehensive review

“…Spontaneous rupture of an AML may result in chronic retroperitoneal hemorrhage or very rarely even in hemorrhagic shock [42]. Rupture of tumor was found in 4.5% of all cases (20 cases).…”

Giant bilateral adrenal myelolipoma:Case presentation and a brief literature review

“… 2 Myelolipomas are relatively slowly growing tumors and tumors exceeding 10 cm in diameter are called giant myelolipomas. 3 , 4 Big tumors can become symptomatic. Symptoms may include nonspecific abdominal pain, constipation, vomiting, hematuria, or renovascular hypertension because of intratumoral hemorrhage or compression of peritumoral tissue.…”

“…Symptoms may include nonspecific abdominal pain, constipation, vomiting, hematuria, or renovascular hypertension because of intratumoral hemorrhage or compression of peritumoral tissue. 3 , 4 …”

“…It may originate from remnants of fetal bone marrow, embolism of bone marrow cells, and hyperplasia of heterotopic reticulum cells. 3 , 4 Another major group of hypotheses relates to hormonal pathways especially bilateral myelolipomas. They have been associated with overproduction of adrenocorticotropic hormone as in Cushing disease and same cases of Congenital adrenal hyperplasia.…”

Are there any Connections between Adrenal Myelolipoma and Hypertension?

“…However, some are diagnosed with AML due to lumbar pain, abdominal pain, dizziness, abnormal level of hormones and so on [4,5]. Some patients present with hypertension and are eventually diagnosed as AML by histopathological biopsy.…”