case_images: PMC4929390_01
case_images: An abdominal CT scan performed on admission showed that the irregular marginal tumor that was approximately 4 cm wide contained necrosis in the central space (black arrows).
case_images: crg-0010-0193-g01.jpg
case_images: PMC4929390_01_crg-0010-0193-g01.jpg
case_images: F1
case_images: A computed tomography (CT) scan performed upon admission showed that the irregular marginal tumor of about 4 cm in width contained necrotic tissue in the central space (fig. 1) as well as a solitary liver metastasis and multiple lung metastases.
case_images: An abdominal CT scan showed hemoperitoneum from a metastatic extragonadal germ cell tumor immediately before the emergency operation (black arrows).
case_images: crg-0010-0193-g02.jpg
case_images: PMC4929390_01_crg-0010-0193-g02.jpg
case_images: F2
case_images: The patient underwent CT examinations that showed hemoperitoneum from a metastatic extragonadal germ cell tumor (fig. 2) and multiple lung metastases (fig. 3).
case_images: The operative scheme showed that venous bleeding from the surface of a metastatic extragonadal germ cell tumor ( ) was found between the ligament of Treitz and the inferior mesenteric vein in a horizontal position. Hemostatic treatment was performed with 4-0 proline thread attached to a medicated cotton sponge (  ).
case_images: crg-0010-0193-g04.jpg
case_images: PMC4929390_01_crg-0010-0193-g04.jpg
case_images: F4
case_images: Therefore, hemostatic treatment was performed with 4-0 proline thread attached to a medicated cotton sponge rather than using a simple proline thread (fig. 4).