Anesthetic management of a missed pheochromocytoma during exploratory laparotomy

Pheochromocytomas are highly vascular and catecholamine producing tumours derived from sympathetic or parasympathetic nervous system, and are estimated to occur in 2-8 out of 1 million population per year; about 0.1% of all hypertensives harbour a pheochromocytoma. Patients usually present with signs and symptoms of sympathetic stimulation, e.g. tachycardia and hypertension etc. We present a rare presentation of pheochromocytoma; a patient with undiagnosed abdominal mass posted for exploratory laparotomy diagnosed to be pheochromocytoma only by histopathology postoperatively. This patient developed intraoperative hypertensive crisis and pulmonary oedema but was managed successfully with proper treatment