Presentation

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CASE STUDY
Karen Fitzmaurice
Urology Cancer Coordinator
Tallaght Hospital
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
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
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
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
Exploration of graft with popliteal
&
pedal embolectomy
• Significant
amount of
thrombus
recovered
• Transferred to
ICU
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.
Right Calf Fasciotomy
Closure of medial fasciotomy &
VAC dressing to lateral
fasciotomy 27/05/13
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
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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