We describe the case of two patients who presented with non-mechanical bowel obstruction as a consequence of an underlying, undiagnosed Phaeochromocytoma. The first patient was referred in to the surgical team by his GP with signs and symptoms of small bowel obstruction. He described abdominal pain, distension and vomiting and had not opened his bowels for a week. The X-ray supported the clinical diagnosis and he went on to have an abdominal CT scan. The scan did not identify an obstructing mass however it did reveal a unilateral 10 cm adrenal tumour. Urine catecholamines were consistent with the diagnosis of phaeochromocytoma. Alpha-blockers were introduced with prompt restoration of normal bowel movements. He went on to have a curative adrenal resection.
The second patient was referred for a surgical opinion on her 8th post-operative day; abdominal pain, distension and vomiting had developed over the course of the day. On examination her abdomen was soft but tender and she appeared to be distended. On account of a progressive deterioration in her clinical parameters; labile hypertension, tachyarrhythmias, and progressive lactic acidosis (14.5 (0.51.6)) she was transferred urgently to the ITU. An abdominal scan was arranged which again did not establish an obstructing lesion but did confirm a locally infiltrative adrenal tumour. Despite radical medical and surgical treatment for a presumed phaeochromocytoma crisis, she died on the ITU. Histology and biochemistry confirmed the diagnosis of a malignant phaeochromocytoma.
Pseudo-obstruction can be caused by Phaeochromocytoma. Pseudo-obstruction was the presenting symptom of undiagnosed Phaeochromocytoma in both the patients described. We advocate greater awareness of this rare association particularly as surgical procedures or certain therapeutic drugs can have fatal consequences in the unprepared patient. By contrast, appropriate medical therapy followed by surgical resection of the Phaeochromocytoma will bring about cure in the majority of cases.