Simultaneous presentation of wilms tumor and obstructing duodenal-jejunal hematoma: A case report

Abstract

Ethan Sandler 1*, Helena Crowley2 , Vijay Krishnan3, Hamad Aljutaili3 , Maram Aljuaid 3,4, Regina Macatangay5

Herein, we discuss the unusual case of a patient with Wilms tumor and completely obstructing duodenal-
jejunal hematoma of unclear etiology. A 5 year old female presented with one week of abdominal pain,
non-bloody non-bilious emesis, and hematuria. On CT imaging, a right sided renal mass along with
an obstructing duodenal and jejunal hematoma were identified. Upon surgical exploration, the tumor
was biopsied, but not resected due to its proximity and dense adherence to the duodenum and other
major vascular structures. A Gastrostomy Tube (GT) and a Jejunostomy Tube (JT) were placed to
bypass the hematoma. Biopsies indicated Wilms Tumor (WT) with favorable histology. The subsequent
treatment plan included nine cycles of chemotherapy with return to or for tumor excision after 7 weeks
of chemotherapy. Repeat imaging about 6 weeks after initial presentation indicated interval increase in
size of right renal mass but resolution of hemoperitoneum and duodenal hematoma. Following tumor
excision, the patient received whole abdomen radiation due to tumor rupture through the capsule along
with chemotherapy protocol per AREN-0533-DD-4A for 25 weeks. This case represents a previously
undocumented associated intraluminal duodenal and jejunal hematoma and a path to safe tumor excision
in the presence of challenging anatomic tumor adherence.
Key Words: Wilms tumor, Idiopathic duodenal hematoma