Perioperative anesthetic management of intestinal pseudo-obstruction as a complication of pheochromocytoma

Abstract

Background: Intestinal pseudo-obstruction, which is a rare complication of pheochromocytoma, can be caused by hypersecreted catecholamines. Case presentation: A 45-year-old woman was admitted for local recurrence of pheochromocytoma complicated by intestinal pseudo-obstruction. The intestinal pseudo-obstruction showed poor response to α-adrenergic receptor blocker and she was scheduled for surgical resection of pheochromocytoma. The surgery was uneventfully accomplished with general anesthesia combined with epidural anesthesia. The latter was performed with the aim of not only perioperative pain management but also of promoting intestinal peristalsis. The anticipated effect for intestinal peristalsis was not apparent in the early postoperative phase. The abdominal symptoms were gradually relieved over the course of about 1 month. Conclusions: For intestinal pseudo-obstruction induced by pheochromocytoma, although inhibition of the sympathetic system by epidural infusion of local anesthetics may be promising, short-term usage of epidural local anesthetics infusion did not provide a quick recovery after pheochromocytoma removal surgery.

Acute intestinal pseudo-obstruction by pheochromocytoma: A case report with review of literature

“…The latter responded well to the surgical removal of the tumor. A very similar case and outcome has been previously reported [11] .…”

A case of pheochromocytoma associated with liver abscess and intestinal pseudo-obstruction

“…Constipation and intestinal pseudo-obstruction are occasionally observed complications of pheochromocytoma caused by hypersecretion of catecholamines, which act on alpha-2-adrenergic receptors of intestinal smooth muscle cells to decrease intestinal movement. 6 , 7 Thosani et al reported that 6% of patients with paragangliomas or pheochromocytomas experienced constipation. In addition, they reported that constipation is a complication usually observed in patients with primary tumors larger than 5 cm, as in this case, or with extensive metastatic disease.…”