Upon arrival to our facility, we were faced with an evolving abdominal compartment syndrome in addition to acute hemorrhage of unclear etiology. In the course of the second laparotomy, hemodynamic instability, the need to address the sequelae of abdominal hypertension, and worsening coagulopathy precluded further exploration of the LUQ for the continued

source of hemorrhage. Moreover, given the presence of bilateral adrenal masses in the setting of a history of MEN2A, further exploration of the adrenals without proper α-blockade presented addition significant risk of morbidity and mortality. Therefore the decision was made to proceed with angiographic embolization in the setting of continued bleeding. TAE as a therapeutic option for pheochromocytoma was first described click here in 1978 by Bunuan [62] and collegues. Their effort to use gel foam TAE was met with significant hemodynamic instability resulting in emergent laparotomy for excision of the necrotic

tumor. Since this initial experience, TAE has been reported in the literature as a palliative option in the management of malignant pheochromocytoma when surgical extirpation is not feasible [63, 64]. LY3009104 More germane to the present case, the use of TAE for management of acute spontaneous intraperitoneal hemorrhage from a pheochromocytoma has not been previously reported, although its use in retroperitoneal hemorrhage as been described by two separate groups [17, 50]. In the present case any further effort to explore the LUQ for the source of hemorrhage may very well have resulted in the patient’s demise. We therefore elected to salvage the situation by employing damage control techniques

Reverse transcriptase to quickly get the patient out of the operating room to facilitate TAE of the suspected hemorrhaging pheochromocytoma. Interestingly, in addition to embolization of a left adrenal artery in this case, a bleeding left Selleck SCH727965 intercostal artery was also identified. In an effort to better define the anatomy of the suprarenal arteries, Toni and colleagues reviewed aortography performed on patients without known suprarenal disease [65]. They identified the origin of the left suprarenal artery as a left intercostal branch in 3% of the patients in their study. As described in all of these reports, post-TAE hypertension can present a formidable challenge. In this case, malignant hypertension was successfully managed with infusion of sodium nitroprusside in the acute setting, followed by administration of phenoxybenzamine. Conclusion Spontaneous intraperitoneal hemorrhage remains a rare complication of pheochromocytoma, though the physiologic consequences present considerable medical and surgical challenges.