Pancreatitis idiopática fibrosante como causa de ictericia obstructiva / Idiopathic fibrosing pancreatitis as a rare cause of obstructive jaundice

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Hematoma suprarrenal por rotura de mielolipoma. A propósito de un caso / Adrenal gland hematoma due to rupture of myelolipoma. A case report

El mielolipoma es un tumor benigno de la corteza suprarrenal, no funcionante y normalmente asintomático, que suele diagnosticarse de forma incidental en pruebas de imagen. La rotura y sangrado del mielolipoma es una complicación poco habitual, que puede concluir en la organización de un hematoma o, raramente, ocasionar hemorragia retroperitoneal masiva. La compresión de estructuras adyacentes por hematomas retroperitoneales (HR) de origen adrenal, es un evento poco frecuente. La indicación quirúrgica del HR continúa siendo, hoy día, una decisión difícil y controvertida, pues suele resolverse con tratamiento conservador y actitud expectante. Presentamos el caso de un varón de 69 años de edad, que acudió a Urgencias por dolor abdominal de 7 días de evolución, cuyo inicio coincidió con traumatismo leve. Las pruebas de imagen revelaron la existencia de hematoma retroperitoneal derecho de 16 cm de posible origen adrenal, con signos de sangrado activo, que colapsaba y desplazaba vena cava. Tan sólo hemos encontrado 1 caso descrito en la literatura de compresión de vena cava secundario a hematoma dependiente de glándula suprarrenal. En nuestro caso fue necesaria laparotomía urgente, suprarrenalectomía derecha y exéresis del hematoma

The myelolipoma is a benign tumour of the adrenal cortex, non functioning and normally asymptomatic, which can be diagnosed by chance in imaging test. Rupture and bleeding of the myelolipoma is an infrequent complication, which can conclude with the formation of a haematoma or, less usually, result in a massive retroperitoneal haemorrhage. The compression of adjacent structures by retroperitoneal haematomas with adrenal origin is a possible but not frequent eventuality. ;;Indications for surgery of haematoma retroperitoneal continue to be, nowadays, a difficult and controversial decision, because the problem is normally resolved with conservative treatment and a watchful approach. ;;We are presented with a 69 year old male who came to casualty with abdominal pain of 7 days duration, whose origin coincided with a light blow. The image test revealed the existence of a retroperitoneal haematoma with adrenal gland origin of 16 cm, with active bleeding, which was displaced and compressed the cava vein. We have only found one case, in the literature, of compression of the cava vein coused by adrenal gland haematoma. In the case under our observation, urgent surgery was needed

[Adrenal gland hematoma due to rupture of myelolipoma. A case report]. / Hematoma suprarrenal por rotura de mielolipoma. A propósito de un caso.

The myelolipoma is a benign tumour of the adrenal cortex, non functioning and normally asymptomatic, which can be diagnosed by chance in imaging test. Rupture and bleeding of the myelolipoma is an infrequent complication, which can conclude with the formation of a haematoma or, less usually, result in a massive retroperitoneal haemorrhage. The compression of adjacent structures by retroperitoneal haematomas with adrenal origin is a possible but not frequent eventuality. Indications for surgery of haematoma retroperitoneal continue to be, nowadays, a difficult and controversial decision, because the problem is normally resolved with conservative treatment and a watchful approach. We are presented with a 69 year old male who came to casualty with abdominal pain of 7 days duration, whose origin coincided with a light blow. The image test revealed the existence of a retroperitoneal haematoma with adrenal gland origin of 16 cm, with active bleeding, which was displaced and compressed the cava vein. We have only found one case, in the literature, of compression of the cava vein coused by adrenal gland haematoma. In the case under our observation, urgent surgery was needed.