A Rare Cause of Acute Abdomen Due to Hemorrhage of Renal Mass: Wunderlich Syndrome
Department of Radiology, Medical Park Göztepe Hospital, İstanbul, Turkey
Department of Radiology, Istanbul Medeniyet University School of Medicine, İstanbul, Turkey
Department of Pathology, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
JEMCR ; : -
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Key Words: Acute abdomen, wunderlich syndrome, angiomyolipoma, perinephric hemorrhage
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.