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CASE STUDY Karen Fitzmaurice Urology Cancer Coordinator Tallaght Hospital.

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Presentation on theme: "CASE STUDY Karen Fitzmaurice Urology Cancer Coordinator Tallaght Hospital."— Presentation transcript:

1 CASE STUDY Karen Fitzmaurice Urology Cancer Coordinator Tallaght Hospital

2 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

3 Presentation Tumour Markers AFP – 1.0 ( ) HCG – 6.2 (<5 ) LDH – 2475 ( ) Testicular exam - NAD Bx. of mass – extra gonadal germ cell tumour – embryonal carcinoma. Sperm banking attempted - no sperm seen

4 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

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7 Surgery Extensive RPLND on 24/05/ 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

8 Exploration of graft with popliteal & pedal embolectomy Significant amount of thrombus recovered Transferred to ICU

9 1 ST 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.

10 Right Calf Fasciotomy

11 Closure of medial fasciotomy & VAC dressing to lateral fasciotomy 27/05/13

12 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

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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