ODP017 A case of an infected pheochromocytoma presenting as an acute abdomen: case report.

This is a case of a 41 years old gentleman who had presented with a 3 day history of severe left sided abdominal pain associated with vomiting 6 years prior in 2015. He had a CT abdomen at that time which showed acute cholecystitis and a left adrenal lesion arising from the lateral limb with a size of 2.8×2.9cm with a HU of 139 and less than 60% washout. He was treated with antibiotics for 3 days however he took an AOR discharge once he felt better. A 24 hour urine cathecolamines were sent during that admission. Subsequently he had defaulted his follow up and presented again 6 years later in May 2021 to another hospital with severe sharp left hypochondriac pain of 2 weeks duration with a pain score of 6/10 associated with vomiting. He was hypertensive at 190/100mmHg, tachycardic at 117 beats/min, febrile at 40 degrees Celcius and had associated hyperglycemia with a blood glucose of 28mmol/L with no metabolic acidosis. His blood investigations revealed a raised white cell count of14.7×10 9 /L with a normal renal and liver profile. He was started on a intravenous antibiotics, variable rate insulin infusion and kept nil by mouth. An urgent CT abdomen done showed a large mass of 9.8×10.1×12.5cm with a mean HU of 25 suggestive of solid cystic mass arising from the left adrenal. His previous cathecolamines from year 2015 was traced and the epinephrine level was 2x elevated at 46mcg/day. He was started on oral Phenoxybenzamine 10mg BD and further titrated to 10mg TDS. Propanolol 40mg BD was given as well. He was only given oral Phenoxybenzamine for 3 days (usually needing 1 week) as an emergency left adrenalectomy was done due to worsening pain not relieved by analgesics and ileus. He had an open left adrenalectomy, splenectomy and distal pancreatectomy. Intraoperative findings weregeneralized pus contamination, stomach, small and large bowel grossly dilated without any perforation, infected left adrenal tumour 10×8cm with no clear plane with distal pancreas including splenic vein due to desmoplastic reaction. During surgery his blood pressure was ranging between 110-140mmHg (systolic) and 60-80mmHg (diastolic). Intra – op, his blood pressure was supported by a low dose noradrenaline which was discontinued within a few hours post surgery. Histopathalogy examination showed neutrophilic infiltrates forming microabscesses with necrosis amounting 60% of the total tumour. The ragged area of the adrenal gland shows mainly inflammation and fibrosis with no evidence of tumour. A final diagnosis of infected pheochromocytoma was given. After surgery, he recovered well and did not need antihypertensives and was discharged with oral glucose lowering agents. Presentation: No date and time listed