presentation
DESCRIPTION
CASE STUDY Karen Fitzmaurice Urology Cancer Coordinator Tallaght Hospital. 25 yr old single man No PMX of note Sept 2012 generally unwell Weight loss Fever Night sweats. Seen by GP CT – large retroperitoneal mass 15 x 12 x 11cms - PowerPoint PPT PresentationTRANSCRIPT
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CASE STUDY Karen Fitzmaurice
Urology Cancer Coordinator Tallaght Hospital
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Presentation• 25 yr old single
man• No PMX of note• Sept 2012
generally unwell• Weight loss• Fever• Night sweats
• Seen by GP
• CT – large retroperitoneal mass
15 x 12 x 11cms
• Referred to Oncology
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Presentation
• Tumour Markers
• AFP – 1.0 (0 - 5.0)• HCG – 6.2 (<5 )• LDH – 2475 (100 - 350)
• Testicular exam - NAD
• Bx. of mass – extra gonadal germ cell tumour – embryonal carcinoma.
• Sperm banking attempted - no sperm seen
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Treatment
• 4 cycles EP (Etoposide & Cysplatin)
• Complicated by intrahepatic thrombosis of the IVC
• Commenced Clexane
• CT - mass reduced in size to
5.2 x 4.2 x 3.7 cms
• Referred to Mr Thornhill
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Surgery
• Extensive RPLND on 24/05/2013 - mass was densely adherent and required an arterial graft from aorta to the right iliac artery.
• Operating time 8 ½ hours
• EBL= 3,600mls
• Developed right leg ischemia in the recovery room & returned to theatre
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Exploration of graft with popliteal &
pedal embolectomy
• Significant amount of thrombus recovered
• Transferred to ICU
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1ST Day Post Op
• Developed right leg pain & reduced ankle movement.
• Possible compartment syndrome (increased pressure within a muscle compartment)
• Patients are at higher risk of compartment syndrome when a blood vessel is damaged & subsequently repaired through surgery.
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Right Calf Fasciotomy
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Closure of medial fasciotomy &VAC dressing to lateral
fasciotomy 27/05/13
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Post Operative care
• MDT – nursing & medical staff, dietician, physiotherapy, Pain team, occupational health, discharge planning.
• PCEA • TPN• NPO, N/G, central line• U/C • Clips & tension sutures• Heparin x 7 days then
clexane
• 6/7 ICU• Weight bear 3/7 post op• Exercises - prevent foot
drop• Resting calf splint • Mobilising frame 2/52 post
op. • Vac dressing x 15 days• Occupational health home
visit• Discharged on 12/06/13
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Discharge
• Convalescence x 1/52• Community physiotherapy• 24/07/13 seen in clinic for histology
results – no evidence of residual viable tumour.
• D/C from urology to oncology.• October 2013 – resumed normal
activity i.e. swimming & cycling.• Continues to attend physiotherapy
sessions.
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