Case Report Incidental Phaeochromocytoma on Staging PET-CT in a Patient with a Sigmoid Tumour and Situs Inversalis Totalis M. R. Boland, 1 A. J. Lowery, 1 S. Walsh, 1 D. Beddy, 2 R. S. Prichard, 1 D. O’Shea, 3 S. J. Skehan, 4 and E. W. McDermott 1 1 he Department of Endocrine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland 2 he Department of Colorectal Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland 3 he Department of Endocrinology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland 4 he Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Correspondence should be addressed to M. R. Boland; mickyboland@gmail.com Received 23 April 2014; Revised 17 June 2014; Accepted 19 June 2014; Published 8 July 2014 Academic Editor: Carmela De Crea Copyright © 2014 M. R. Boland et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. An adrenal “incidentaloma” is deined as an unexpected inding on radiological imaging performed for unrelated indications. Improvements in radiological technology have seen a dramatic increase in this phenomenon. We report the unique case of a 60-year- old female presenting with a 6-month history of abdominal pain, altered bowel habit, and rectal bleeding. Her past medical history included situs inversus totalis and a patent ductus arteriosus. Colonoscopy revealed an ulcerated tumour in her sigmoid colon. Staging PET-CT conirmed a sigmoid tumour and also identiied a large heterogenous enhancing FDG-avid right adrenal mass. Biochemical testing/MIBG imaging conirmed a right adrenal phaeochromocytoma. Hypertension was controlled and excision was performed via a transperitoneal laparoscopic adrenalectomy, in the let lateral decubitus position. Uniquely, liver retraction was not required due to its position in the let hypochondrium. Histology conirmed a benign 46 mm phaeochromocytoma. Subsequent uncomplicated sigmoid colectomy/right salpingo-oophorectomy for a locally advanced colonic tumour was performed with adjuvant chemotherapy. his case highlights the importance of accurately identifying functioning adrenal tumours before elective surgery as undiagnosed phaeochromocytomas carry signiicant intraoperative morbidity/mortality. Right adrenalectomy was made easier in this patient by the liver’s unique position. Uncomplicated colorectal resection was made possible by combined preoperative functional/anatomical imaging. 1. Introduction he increasing incidence of adrenal incidentalomas identiied by improved radiological techniques has been mirrored by an increase in the incidence of asymptomatic phaeochromo- cytomas [1]. he treatment of these functional lesions can be challenging especially in the rare setting of situs inversus totalis. 2. Presentation of Case We report the case of a 60-year-old female who presented with a six-month history of intermittent crampy abdominal pain associated with an alteration in her bowel habit and two episodes of rectal bleeding. Her background medical history included situs inversus totalis combined with a congenital patent ductus arteriosus, mitral regurgitation which required placement of a metallic mitral valve, complete heart block requiring placement of a dual chamber pacemaker, and dilated cardiomyopathy with an ejection fraction of 24%. She also had a longstanding history of hypertension. Her medi- cations included telmisartan 20 mg daily per oral (PO), biso- prolol 2.5 mg daily PO, furosemide/amiloride 40 mg/5 mg daily PO, and warfarin 6 mg daily PO or as per regular international normalised ratios. She was an ex-smoker and reported no history of familial syndromes. he patient underwent a colonoscopy which showed an ulcerated sigmoid lesion at 50 cm. Biopsy was not performed due to the patient’s ongoing anticoagulation. She proceeded to have a staging Positron Emission Tomography-Computed Hindawi Publishing Corporation Case Reports in Surgery Volume 2014, Article ID 645462, 4 pages http://dx.doi.org/10.1155/2014/645462