Simultaneous presentation of wilms tumor and obstructing duodenal-jejunal hematoma: A case report

Abstract

Ethan Sandler*, Helena Crowley, Vijay Krishnan, Hamad Aljutaili, Maram Aljuaid and Regina Macatangay

Herein, we discuss the unusual case of a patient with Wilms tumor and completely obstructing duodenal- jejunal hematoma of unclear etiology. A 5 year old female presented with one week of abdominal pain, non-bloody non-bilious emesis, and hematuria. On CT imaging, a right sided renal mass along with an obstructing duodenal and jejunal hematoma were identified. Upon surgical exploration, the tumor was biopsied, but not resected due to its proximity and dense adherence to the duodenum and other major vascular structures. A Gastrostomy Tube (GT) and a Jejunostomy Tube (JT) were placed to bypass the hematoma. Biopsies indicated Wilms Tumor (WT) with favorable histology. The subsequent treatment plan included nine cycles of chemotherapy with return to or for tumor excision after 7 weeks of chemotherapy. Repeat imaging about 6 weeks after initial presentation indicated interval increase in size of right renal mass but resolution of hemoperitoneum and duodenal hematoma. Following tumor excision, the patient received whole abdomen radiation due to tumor rupture through the capsule along with chemotherapy protocol per AREN-0533-DD-4A for 25 weeks. This case represents a previously undocumented associated intraluminal duodenal and jejunal hematoma and a path to safe tumor excision in the presence of challenging anatomic tumor adherence.