Cephalic Pancreaticoduodenectomy With Right Nephrectomy for Traumatic Ruptured Wilms Tumor

TL;DR

A three-year-old child with a ruptured Wilms tumor required emergency surgery involving multiple organ resections after trauma.

Contribution

This case report highlights the necessity of multivisceral emergency resection in traumatic Wilms tumor rupture with life-threatening complications.

Findings

Emergency surgery was required due to persistent hemodynamic decompensation after trauma.

A cephalic pancreaticoduodenectomy with right nephrectomy was performed for tumor rupture and grade V duodenal injury.

Multi-visceral resection was necessary to address injuries from tumor rupture and maintain oncologic principles.

Abstract

Wilms tumor is the most common pediatric extracranial solid tumor in Peru. Preoperative tumor rupture is an uncommon complication, and its management varies depending on the severity. If the bleeding is self-limited, does not affect hemodynamic stability, or is controlled with medical management, surgery may be delayed until after neoadjuvant chemotherapy.

This report describes a three-year-old male patient with a right Wilms tumor extending into the ipsilateral renal vein, accompanied by bulky retroperitoneal lymph nodes and multiple bilateral pulmonary metastases. He presented with severe abdominal pain and distension following abdominal trauma. Due to persistent hemodynamic decompensation after initial medical management, an emergency laparotomy was required. A devascularized duodenum adjacent to an area of extensive tumor bleeding confirmed a preoperative tumor rupture and a grade V duodenal injury. These findings necessitated a multivisceral emergency resection. The surgery included a right nephrectomy with en-bloc thrombectomy, resection of macroscopic lymph node metastases, and a cephalic pancreaticoduodenectomy.

Tumor rupture must be evaluated both clinically and radiologically to determine the safest course of treatment. Life-threatening hemodynamic decompensation unresponsive to medical management requires emergency surgery. Although multi-visceral resection is not the preferred approach for the initial management of Wilms tumor, it may become necessary due to injuries associated with tumor rupture. In such emergency oncologic surgeries, the selected techniques must uphold oncologic principles, minimize the risk of serious complications, and effectively address the underlying emergency.

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