Ganglioneuroma przestrzeni zaotrzewnowej: analiza powikłań po leczeniu chirurgicznym

2016 
Abstract Ganglioneuroma is a relatively rare pediatric tumor, regarded as mature and highly differentiated non-malignant pathology of autonomic peripheral sympathetic nervous system. In comparison to neuroblastoma, this tumor more frequently occurs in girls, at median age of 7 years, more frequently in mediastinal and less frequently in abdominal localization. Practically, it always has localized stage. Patients with ganglioneuroma have normal activity of lactic dehydrogenase (LDH), ferritin, neurospecific enolase and usually normal urine 24-hour content of vanillylmandelic acid, homovanillylmandelic acid, adrenaline and dopamine. The therapy of choice is the total surgical resection of tumor. In case of gross tumor or unfavorable localization, the resection requires advanced surgical technique, and might be followed by complications in up to 16% of treated patients. In half of the cases, complications might be severe and life threatening. In this paper, we describe a 10-year-old girl, who was diagnosed for ganglioneuroma. After radical tumor resection, only transient local ischemia of right liver lobe occurred; however, during postoperative period, the patient was faced with intraperitoneal biliary fluid collection. Patient was qualified to re-laparotomy and perforation of extrahepatic biliary tract was discovered. The damage was restored with the use of the Kehr drain. In the postoperative period, we carried on endoscopic assessment and common biliary duct together with pancreatic duct were stented. Few weeks after prostheses removal a severe cholestasis appeared, and critical stenosis of the common biliary duct was found. Several attempts of endoscopic stenting were undertaken and were unsuccessful. After detailed radiologic studies, the girl was qualified to subsequent surgery; a hepaticoenterostomy was performed – anastomosis of common hepatic duct to the Roux-en-Y loop. During the uncomplicated postoperative period there were no signs of cholestasis or cholecystitis. After full intraoral feeding was reached, the girl was sent home on the 13 th postoperative day.
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