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

Abstract

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.