Quaint Partners: Pheochromocytoma and Sealed Duodenal Perforation

Introduction: A pheochromocytoma is a rare Ecatecholamine producing adrenal tumor. Pheochromocytoma, along with duodenal perforation is a unique combination. Case summary: A 40 year's male presented with abdominal pain for the last month. He also had history of episodic headache, flushing and palpitation. The patient was further evaluated, Blood and urine metanephrines were found to be elevated, and radiological studies were suggestive of Right Adrenal mass 8x7 cms. After optimization, he was considered for surgery. Along with Right adrenal mass, one sealed perforation .75x.75 cms was seen in the first part of duodenum with scarring and minimal spillage. Excision of right adrenal mass along with duodenal ulcer perforation closure with an omental flap was done. The histopathology was suggestive of pheochromocytoma. The histopathology of the duodenal ulcer margin was suggestive of chronic inflammation and scarring in duodenal tissue. Conclusion: Pheochromocytoma is a great masquerader. The pheochromocytoma association with a duodenal ulcer is more than a coincidence. Phaeochromocytoma should always kept in mind in atypical cases of abdominal pain.