SHM Converge Scientific Abstract ePoster Gallery-House Episode: "Acceptance". A Rare Complication of a Rare Disease...

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This case describes a 59-year-old man with hypertension, type 2 diabetes, and prior splenectomy who presented with two weeks of constipation, flushing, sweating, palpitations, and severe orthostatic symptoms. He was found to have marked tachycardia, hypertension, and a 5.1 cm right adrenal mass. Urine testing confirmed pheochromocytoma. He was started on alpha- and beta-blockade in preparation for resection.<br /><br />Before surgery could occur, a PET/CT showed pneumoperitoneum, and he underwent emergent exploratory laparotomy. Surgeons found a perforated distal ileum, which was resected along with the pheochromocytoma. Pathology of the bowel tissue revealed mucormycosis and CMV infection. He later developed an anastomotic leak, but further surgery was declined. Despite medical care, his condition worsened and he transitioned to inpatient hospice.<br /><br />The teaching point is that bowel perforation can occur as a rare but life-threatening complication of pheochromocytoma, likely due to catecholamine-induced decreased intestinal motility and bowel ischemia. Constipation is an important warning sign, and standard catecholamine blockade may not fully prevent gastrointestinal complications. Patients with pheochromocytoma should be closely monitored and managed with aggressive bowel regimens.<br /><br />The discussion emphasizes that pheochromocytoma should be considered in patients with resistant hypertension, episodic adrenergic symptoms, or adrenal masses. GI complications such as constipation, bleeding, ileus, and perforation are underrecognized. The case also notes uncertainty about the source of mucormycosis, with possible contributions from nasogastric tube placement, asplenia, diabetes, and ischemic bowel.

Asset Subtitle

Jennifer J. McEntee

Meta Tag

Author List Jennifer J. McEntee, John Barber

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Resistant Hypertension

Concept Catecholamine Excess

Concept Alpha Blockade

Concept Hyperadrenergic Symptoms

Distinguished Non-Finalist

Presenter Organization Unc

Presenting Author Jennifer J. McEntee

Track Adult

Keywords

pheochromocytoma

bowel perforation

constipation

adrenal mass

catecholamine excess

hypertension

orthostatic symptoms

mucormycosis

CMV infection

ileal perforation

Pheochromocytoma

Resistant Hypertension

Catecholamine Excess

Alpha Blockade

Hyperadrenergic Symptoms