Abstract
This chapter, reviews the basics for children undergoing abdominal mass resections. Combined with the chapter on neuroblastoma, the authors discuss the incidence, diagnosis and perioperative considerations for patients undergoing resection of large abdominal tumors. The anesthetic evaluation and planning for these patients is presented with the relative tumor specific management principles.
A 20-month-old girl presents with abdominal distension and a palpable, firm mass in her right abdomen. Ultrasound and CT exams confirm an intra-abdominal mass, and she is scheduled for open resection. Vital signs include: Temp 37.6°C, BP 116/79, HR 88 bpm, SpO2 100%. Heart and lung sounds are normal.
What Is the Differential Diagnosis for This Child’s Abdominal Mass?
Pediatric abdominal malignancies to consider include neuroblastoma, Wilms tumor (nephroblastoma), lymphoma, rhabdomyosarcoma, renal cell carcinoma, leiomyosarcoma, teratoma, and germ cell tumors (see Chapter 24). Other organ pathologies that may present as an abdominal mass include polycystic kidney disease, Meckel’s diverticulum, and hepatic storage diseases.
What Is the Incidence and Epidemiology of Wilms Tumor?
There are approximately 500 new cases of Wilms tumor annually in the United States. It is the most common renal malignancy in young children, while renal cell carcinoma is more common in adults and children older than 15 years. Most cases are diagnosed before five years of age, while nearly all are diagnosed before 10 years of age.
What Congenital Syndromes Are Associated with Wilms Tumor?
Most cases of Wilms tumor are sporadic. A minority of cases are part of congenital syndromes including WAGR (Wilms tumor, aniridia, genitourinary anomalies, intellectual disability) syndrome, Beckwith–Wiedemann syndrome, Perlman syndrome, and Sotos syndrome.
What Anesthetic Concerns Do You Have for Wilms Tumor Resection?
Neoadjuvant chemotherapy is often given before surgery and related toxicities may be present, similar to those described in neuroblastoma as discussed in Chapter 24. For those previously exposed to anthracyclines, a preoperative cardiac workup should be obtained including echocardiography. Serum creatinine and electrolytes should be checked, although most patients present with normal renal function (even with bilateral disease). Coagulation status should be evaluated as 10% of patients have an acquired von Willebrand disorder. A particularly important condition to rule out is renal vein and inferior vena cava (IVC) invasion. Intravascular tumor extension increases the risk of pulmonary tumor embolization, and presence of tumor in the IVC or cardiac chambers must be considered if obtaining central venous access. If the tumor is associated with a congenital syndrome, preparation should be made for associated anesthetic concerns, such as difficult airway due to macroglossia in Beckwith-Wiedemann and Sotos syndromes.
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