Translational pediatrics · 2026
Delayed rupture of the celiac trunk and superior mesenteric artery associated with pancreatic leakage after resection of a giant retroperitoneal ganglioneuroblastoma in a child: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Dai Xueman, Chang Xiaofeng, Shi Junlei, Zong Congran, Zhao Shanshan, Wang Huanmin
Аннотация
BACKGROUND: Giant retroperitoneal neurogenic tumors in children frequently encase major abdominal vessels, rendering complete resection technically challenging. Although postoperative pancreatic leakage is rare, it may result in catastrophic vascular complications when major vessels are exposed.
CASE DESCRIPTION: A previously healthy 9-year-old boy presented with nausea and vomiting and was found to have a giant retroperitoneal mass encasing the celiac trunk and superior mesenteric artery (SMA). Complete macroscopic resection was achieved, and histopathology confirmed intermixed ganglioneuroblastoma. Postoperatively, the patient developed pancreatic leakage, with drain fluid amylase exceeding three times the serum level, and was managed conservatively with somatostatin and adequate drainage. A bile leak was identified on postoperative day (POD) 11, with persistent bile-stained drainage but normal serum bilirubin levels. On POD 18, the patient abruptly developed massive hemorrhagic drainage, gastrointestinal bleeding, and hemodynamic instability. Computed tomography angiography (CTA) and catheter angiography revealed a pseudoaneurysm arising from the SMA. Emergency laparotomy confirmed rupture of both the celiac trunk and SMA. After proximal aortic control, the celiac trunk was ligated, and SMA continuity was restored using a 15-cm autologous great saphenous vein interposition graft. Biliary reconstruction was performed via Roux-en-Y hepaticojejunostomy. The patient recovered uneventfully, with patent mesenteric circulation on follow-up imaging and no tumor recurrence during 12 months of follow-up.
CONCLUSIONS: Pancreatic leakage after resection of giant retroperitoneal tumors may be associated with delayed arterial rupture. In patients with postoperative pancreatic leakage, sudden onset of hemorrhagic drainage or gastrointestinal bleeding should prompt immediate vascular imaging and timely surgical intervention to prevent fatal outcomes.
CASE DESCRIPTION: A previously healthy 9-year-old boy presented with nausea and vomiting and was found to have a giant retroperitoneal mass encasing the celiac trunk and superior mesenteric artery (SMA). Complete macroscopic resection was achieved, and histopathology confirmed intermixed ganglioneuroblastoma. Postoperatively, the patient developed pancreatic leakage, with drain fluid amylase exceeding three times the serum level, and was managed conservatively with somatostatin and adequate drainage. A bile leak was identified on postoperative day (POD) 11, with persistent bile-stained drainage but normal serum bilirubin levels. On POD 18, the patient abruptly developed massive hemorrhagic drainage, gastrointestinal bleeding, and hemodynamic instability. Computed tomography angiography (CTA) and catheter angiography revealed a pseudoaneurysm arising from the SMA. Emergency laparotomy confirmed rupture of both the celiac trunk and SMA. After proximal aortic control, the celiac trunk was ligated, and SMA continuity was restored using a 15-cm autologous great saphenous vein interposition graft. Biliary reconstruction was performed via Roux-en-Y hepaticojejunostomy. The patient recovered uneventfully, with patent mesenteric circulation on follow-up imaging and no tumor recurrence during 12 months of follow-up.
CONCLUSIONS: Pancreatic leakage after resection of giant retroperitoneal tumors may be associated with delayed arterial rupture. In patients with postoperative pancreatic leakage, sudden onset of hemorrhagic drainage or gastrointestinal bleeding should prompt immediate vascular imaging and timely surgical intervention to prevent fatal outcomes.