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

Abstract

Renal angiomyolipomas are rare benign lesions of the kidney with an incidence between 0.1% and 0.22% (1). They are composed of abnormal vasculature, smooth muscle, and adipose tissue. They are more likely to be symptomatic if they are larger than 4 cm, and present a history of flank pain, a palpable mass, and rarely haematuria. Also, they are most frequent etiology of Wunderlich syndrome, which is an emergency medical condition that refers to spontaneous nontraumatic bleeding confined to the perinephric space (2). Although benign, their rich neovascularization has a tendency for spontaneous rupture with consequent hemorrhage, which in some cases can be life threatening. Significant perinephric hemorrhage may occur in approximately 10% of patients with angiomyolipoma (3). This complication is related to the size of the tumor, the grade of the angiogenic component of the tumor, and the presence of tuberous. Herein, we present a catastrophic case of Wunderlich syndrome whose vital signs abruptly worsened, went into hypovolemic shock and required an urgent surgical approach.