Introduction

Retroperitoneal masses can present significant challenges in diagnosis and management, particularly in elderly patients. This case study discusses the surgical management of a large retroperitoneal mass in a 78-year-old male, detailing the clinical presentation, diagnostic workup, surgical intervention, and postoperative outcomes.

Case Presentation

Patient Profile:

Age: 78 years

Sex: Male

Medical History: The patient had a history of pain in the abdomen for the last 4 to 5 years, which went unnoticed, and finally, he consulted a local physician for a check-up when his pain had become unbearable. After initial evaluation by the general physician, he was referred to Narayana Health’s Urology Department for further management as his case was complicated. A CECT revealed a 7.1x6.5x5.7 cm sized progressively enhancing lesion with prominent intralesional vessels in the retroperitoneum at the level of the left renal hilum, away from it. The lesion abutted the aorta for more than 25% of the aortic circumference.

Physical Examination:

Abdominal examination revealed a large, non-tender, palpable mass in the left flank extending into the epigastric region.

Procedure:

The patient was scheduled for surgical intervention under general anaesthesia.

Surgical Technique: Foley catheterization was done first, after which a midline incision was performed. The descending colon was mobilised, and the kidney was identified. The was found to be lying medial to the kidney. Dissection of the ureter was done, followed by a gonadal clipper & cut. Duodenum was identified. The renal vein & renal artery were also identified. However, we noticed tumour to be attached to the renal vein. The tumour was mobilised from the aorta and removed along with the kidney. The tumour hard mass was about 15x10cm and found in the retroperitoneum stuck to the renal vein, as mentioned before. The tumour & left kidney was sent for examination.

Postoperative Care

The patient was transferred to the recovery unit and monitored closely. His postoperative course included:
Management of pain with intravenous analgesics transitioning to oral medications.
Early mobilisation is encouraged on postoperative day 1.
Monitoring for any signs of complications such as bleeding, infection, or urinary obstruction.
Hospital Stay: The patient was discharged on postoperative day 5 without complications, with follow-up appointments scheduled for pathology results and further management.

Discussion

This case illustrates the complexities of managing a large retroperitoneal mass in an elderly patient. While such masses may present diagnostic challenges, thorough imaging, and histopathological evaluation are critical for appropriate management. Surgical resection remains the cornerstone of treatment.

Conclusion

The successful removal of a large retroperitoneal mass in a 78-year-old male demonstrates the effectiveness of surgical intervention in the management of retroperitoneal tumours. Continuous follow-up is essential for early detection of recurrence or complications, underscoring the importance of a multidisciplinary approach in managing such complex cases. Age, along with other complications, was a huge factor in this case. However, the patient is doing fine now and is also being monitored through frequent follow-ups.

Narayana Health's Urology Department is dedicated to providing advanced, personalised care for complex cases like large retroperitoneal masses. This case exemplifies our commitment to meticulous diagnosis, skilled surgical intervention, and comprehensive post-operative care, ensuring positive outcomes even in challenging scenarios.

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