Case 5
CASE DESCRIPTION
A 23-year-old young boy presented to us in an extreme distress with bilateral tubes placed in the kidney (PCN) as patient was not able to pass urine on her own because of a large retroperitoneal mass encasing the ureter, aorta, common iliac veins and left renal artery . He was in a condition of failure to thrive. On the CT scan, we could not see the branches of the aorta. He was put on neoadjuvant chemotherapy outside but the disease progressed and his mental will power started giving up. He visited multiple centres in India and also took opinions from Singapore. The response was that it could not be operated on and that there was a high chance he would die on the table. Somehow, Google helped him reach us for one more opinion.
Consultation and diagnosis
Prompt and accurate diagnosis made in-house
Tumour board
A multi-disciplinary team deliberated on action
Individualized care
Patient’s mental makeup taken into consideration
Modular care
A suite of therapies that contribute to holistic healing
WHAT WE DID
The first thing that came to my mind: he is a young patient with a germ cell tumour (Mature Teratoma) that does not respond to chemotherapy, and he was struggling with his life not being able to eat and walk normally. Since it was a Germ cell tumour, we can always operate with good outcomes. I counseled him that we would perform surgery and assuaged his worries. We had a multidisciplinary meeting, and we planned our surgery with an Intensivist, vascular surgeon, and anaesthetist. The entire team was motivated. We could successfully remove the entire retroperitoneal tumour, which took more than 12 hours and required a massive blood transfusion. The universe seemed to be supporting us.
- Tumour board involved
- Counseling for the patient
- Germ cell tumour – Good Biology
- Arduous surgery performed
- Massive blood transfusion managed well by team
FINAL RESULTS
Postoperatively, he required an ICU stay for 4-5 days and he recovered well. All his PCN tubes were removed. He was able to eat and pass urine on his own. He gained 5 kg weight after 2 months. The first follow-up CT scan showed no disease recurrence at the operative site at 4 months and now it is almost a year he is doing well.
Learning: A personalised approach with an excellently skilled team and universe support can change outcomes.
