Case study karen fitzmaurice urology cancer coordinator tallaght hospital
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CASE STUDY Karen Fitzmaurice Urology Cancer Coordinator Tallaght Hospital. 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

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Case study karen fitzmaurice urology cancer coordinator tallaght hospital

CASE STUDYKaren Fitzmaurice Urology Cancer Coordinator Tallaght Hospital


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

Presentation


Presentation1

Tumour Markers

AFP – 1.0 (0 - 5.0)

HCG – 6.2 (<5 )

LDH – 2475 (100 - 350)

Testicular exam - NAD

Bx. of mass – extra gonadal germ cell tumour – embryonal carcinoma.

Sperm banking attempted - no sperm seen

Presentation


Treatment
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


Surgery
Surgery

  • Extensive RPLND on 24/05/2013 - 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


Exploration of graft with popliteal pedal embolectomy

Significant amount of thrombus recovered

Transferred to ICU

Exploration of graft with popliteal & pedal embolectomy


1 st day post op
1ST 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.



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


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

Post Operative care


Discharge
Discharge Pain team, occupational health, discharge planning.

  • 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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