Case report – Male, 54 years old, with growing abdominal mass
causistic date: 24.06.2008, published: 24.06.2008
Dr. Roman Šefr, Head of the Digestive Oncology Committee, Department of Surgical Oncology, Masaryk Memorial Institute in Brno.
A 54-year-old male was examined for a growing abdominal mass that had been expanding for several months. After examination, the patient was prepared for surgery that was carried out at a regional hospital. However, the condition was assessed as inoperable due to the excessive size of the tumor embedded in adjacent structures. Histological examination of samples taken during the procedure suggested the existence of a malign tumor in the abdominal cavity and retroperitoneum. With such a finding, the patient was sent to a regional university hospital and subsequently to Masaryk Memorial Cancer Institute in Brno.
Preoperative examination confirmed the infiltration of fatty tissue with a large malign tumor, particularly in the retroperitoneum, reaching also to abdominal cavity and partially pushing aside as well as suppressing surrounding tissues and organs.
The surgical procedure was performed on 26 July 2006 after oncosurgical planning and necessary preparation of the patient. The abdominal cavity was approached through a middle laparotomy, from processus xyphoideus to symphisis. Dominating in the clinical picture is a large tumor in fatty tissue growing out from the retroperitoneum which takes up also a considerable part of the peritoneal cavity, covering in total 2/3 of the space from the pancreas to small pelvis. The finding is on the verge of inoperability because in the retroperitoneum the tumor is firmly attached, particularly to backbone surrounding structures, penetrating into the right kidney and ureter. In view of the pressure exerted on the surrounding tissues and organs and virtual impossibility to close the abdominal cavity without reduction of tumor mass, the tumor is gradually released from its socket, even though its attachment to the surrounding tissue is extensive. Tissues are saturated with blood, fragile and haemorrhagic, as is common in these findings.
Fortunately, the patient does not suffer from a haemocoagulability disorder.
After several hours of intensive preparation the tumor is released so that it “only” remains attached to the paravertebral muscles on the left side of the backbone, from the lower pole of the left kidney up to the caudal edge of musculus psoas.
Here it was necessary to sever the tumor even with a part of the paravertebral muscles infiltrated by the tumor so that this phase of the procedure is radical enough as well. The haemorrhage from muscle fasciculi was relatively intensive, as expected, and not all of its sources were spot sources; this haemorrhage from the wound caused was rather of a diffuse character. To stop this bleeding, Traumastem TAF/TAF light, in its largest available size, was used to the benefit of the patient. In total, 3 reticula were used particularly to cover the uncovered intersected muscle tissues – large, capillary bleeding wound areas. The created cavity was further filled by a part of omentum and drained by a tygon drain.
After extraction from the body, the tumor was weighed – 9.5 kg. Post-operative development was smooth, without complications. The drain was extracted 5 days after the surgery. No signs of haemorrhage or other complications were identified. Diabetes mellitus was well-compensated.
Histological finding: G III retroperitoneal liposarcoma, mixed type. The patient is dispensarized in Masaryk Memorial Cancer Institute where he comes for regular checks. In this case, Traumastem TAF/TAF light greatly helped to stop bleeding from a large wound in the retroperitoneum. At the same time, its application prevented haemorrhage in the early as well as later post-operative stages.
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