A Rare Cause of Acute Abdomen Due to Hemorrhage of Renal Mass: Wunderlich Syndrome

Yıl 2017, Cilt: 8 Sayı: 3, 55 - 58, 01.07.2017

Umut Özdamarlar Ercan Ayaz , Zafer Küçükodacı Emin Değer Mustafa Kemal Demir

Öz

-

Anahtar Kelimeler

-

A Rare Cause of Acute Abdomen Due to Hemorrhage of Renal Mass: Wunderlich Syndrome

Öz

Introduction: Wunderlich syndrome is an emergency medical condition that refers to spontaneous nontraumatic bleeding confined to the perinephric space. Renal angiomyolipomas are the most frequent etiology. Herein, we present a case of Wunderlich syndrome whose vital signs abruptly worsened and went into hypovolemic shock and required an urgent surgical approach.Case Report: A 55 year old woman applied to our emergency room with flank pain for 4 days, which worsened severely that morning. In her physical examination, her abdomen was tight and tender and she felt pain with palpation on the left flank. Her abdomen sonography revealed a mass in the upper pole of her left kidney consistent with angiomyolipoma. Also there was subcapsular fluid collection. Intravenous (IV) contrast enhanced computerized tomography (CT) was done immediately, which showed a 9.5 cm diameter mass with arterial contrast extravasation into the mass and subcapsular area. There was a large perinephric hematoma. After 2 hours in the emergency room the patient became haemodynamically unstable and entered the operation room with hypovolemic shock. Radical nephrectomy was performed.Conclusion: Wunderlich syndrome is a rare cause of acute abdomen. Therefore, urgent and specific management to diagnose and treat it as soon as possible is needed in cooperation with emergency doctors, radiologists, and urologists

Anahtar Kelimeler

Acute abdomen, wunderlich syndrome, angiomyolipoma, perinephric hemorrhage

Kaynakça

• Oesterling JE, Fishman EK, Goldman SM, Marshall FF. The management of renal angiomyolipoma. J Urol 1986; 135: 1121-4.
• Fujii Y, Ajima J, Oka K, Tosaka A, Takehara Y. Benign renal tumors detected among healthy adults by abdominal ultrasonography. Eur Urol 1995; 27: 124-7.
• Moratalla MB. Wunderlich’s syndrome due to spontaneous rupture of large bilateral angiomyolipomas. Emerg Med J 2009; 26: 72. [CrossRef ]
• Wunderlich CRA. Handbuch der Pathologie und Therapie. 2 nd ed. Stuttgart: Ebner& Subert 1856.
• Albi G, del Campo L, Taggaro D. Wünderlich’s Syndrome: causes, diagnosis and radiological management. Clin Radiol 2002; 57: 840-5. [CrossRef ]
• Zhang JQ, Feilding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 2002; 167: 1593-6. [CrossRef ]
• Simmons JL, Hussain SA, Riley P, Wallace DM. Management of renal angiomyolipoma in patients with tuberous sclerosis complex. Oncol Rep 2003; 10: 237–41. [CrossRef ]
• Chan CK, Yu S, Yip S, Lee P. The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology 2011; 77: 642-8. [CrossRef ]
• Eble JN. Angiomyolipoma of kidney. Semin Diagn Pathol 1998; 15: 21- 40.
• Nelson CP, Sanda MG. Contemporary diagnosis and management of renal angiomyolipoma. J Urol 2002; 168: 1315 -25.[CrossRef ]