Abstract
Spontaneous adrenal hemorrhage is a rare cause of acute abdominal pain. Systemic disorders that deregulate normal hemostasis and the use of anticoagulants are both considered predisposing factors for this unusual condition. Questions still remain in the case of hemorrhage in previously diagnosed incidentalomas. Spontaneous hemorrhage in this setting increases the suspicion of occult malignancy or pheochromocytoma. On the other hand, the presence of a retroperitoneal hematoma can make laparoscopic excision of such lesions technically challenging in the acute setting. In the present study we report the case of spontaneous adrenal hemorrhage associated with oral anticoagulant use in a previously diagnosed incidentaloma. After initial stabilization, the patient was subjected to laparoscopic right adrenalectomy within 72 hours of the onset of symptoms. The patient was discharged on the second postoperative day. Biopsy revealed a benign adrenal adenoma. Prompt laparoscopic adrenalectomy is the treatment of choice in hemodynamically stable patients presenting with hemorrhage in a known adrenal tumor.
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Nixon, A.M., Aggeli, C., Parianos, C. et al. Laparoscopic right adrenalectomy for spontaneous hemorrhage in an adrenal incidentaloma, presenting as a case of acute surgical abdomen. Hellenic J Surg 88, 436–438 (2016). https://doi.org/10.1007/s13126-016-0368-9
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DOI: https://doi.org/10.1007/s13126-016-0368-9