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Surgery: Case Report

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Treatment difficulties during COVID 19 pandemic in a patient with giant renal tumor: A small town general hospital perspective

Author(s): Élthes Etele, Szöllösi Attila*, Fetés Péter, Borbáth Anikó and Rápolti Emese

INTRODUCTION: We present an unusual case of papillary renal cell carcinoma, which is a rare subtype of kidney malignancy. Objective: The present case report emphasizes a voluminous left renal tumoral mass causing bowel obstruction and necessity of emergency surgical intervention. CASE PRESENTATION: A 74-year-old patient with a history of multiple severe cardiovascular conditions, presented in the emergency room accusing abdominal distension and pain, nausea, vomiting and lack of intestinal transit for about 72 hours. Based on the symptomatology, physical examination and imagistic explorations a clinical diagnosis of bowel obstruction was arisen, caused by a voluminous tumor with compression of the large vessels and invasion of the left colon. Given the severity of the cardiovascular comorbidities and the complexity of the case, the possibility of patient’s transfer to a university hospital was arisen, which was not practicable due to the COVID-19 pandemic. During surgical intervention en-bloc resection of the left kidney and tumoral mass was practiced. Histopathologic examination identified the tumoral mass as type I papillary carcinoma of the left kidney. The postoperative evolution was unfavorable, due to the severe cardiovascular comorbidities, on maximal vasoactive support the patient remained hemodynamically unstable, showed progressive myocardial infarction with the persistence of arrhythmias and severely reduced ejection fraction which led to his unfortunate death. CONCLUSION: Careful patient selection is needed to ensure a favorable risk-benefit ratio. Also a thorough multidisciplinary evaluation of patient and the possible therapeutic options is necessary, in order to create an optimal and individualized treatment plan hydatid nature of the lesion. The definitive diagnosis remains histological and the treatment is always surgical. We report an observation of a breast hydatid cyst discovered incidentally.

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