A Renal Cause for Massive Retroperitoneal Hemorrhage—renal Angiomyolipoma

Abstract

In any case of intra-abdominal trauma or hemorrhage a preoperative IVP is essential to determine the renal status. Preoperative catheter occlusion of the renal artery in these vascular tumors may be attempted to decrease blood loss. Stigmas of tuberous sclerosis should be sought in patients with vascular renal tumors, especially if they are bilateral. Conservation of renal tissue in tuberous sclerotic patients harboring renal angiomyolipomas is important.

Angiomyolipoma Causing Spontaneous Rupture of the Kidney

“…Symptoms of urinary tract infection and hypertension occur less commonly [Barrilero, 1977]. As illustrated in our case, angiomyoli poma may also present as an emergency because of spon taneous rupture of the tumour and massive retroperito neal haemorrhage in a patient previously free of urologic symptoms [McDougal et al, 1975;Beh et al, 1976;Hoel and Tollefsen, 1976].…”

“…In these cases, a nephrec tomy should be done immediately assuming that the kid ney on the opposite side is normal [McDougal et al, 1975;Beh et al, 1976]. In our case, this ought to have been demonstrated by performing an intravenous uro gram per-operatively.…”

Sarcomatous Carcinoma of the Kidney Presenting as Spontaneous Retroperitoneal Hemorrhage

“…In our patient the peripheral location of the tumor, eroding through the renal capsule, is the most likely explanation and this fact has been demonstrated in other cases [14,15], Symptoms of SPH are usually due to hemorrhage into or from a tumor, the most frequent presenting features being loin or abdomi nal pain, a tender flank mass and signs of hemorrhagic shock (Lenk's triad) [7]; macro-or microscopic hematuria is often present. As in our case, spontaneous rupture of the tumor may also present itself as an emergency because of massive retroperitoneal hemorrhage in a patient previously free of urologie symptoms [1,4]. Out of the 78 cases of SPH reviewed by McDougall et al [1], only 25 (32.5%) presented themselves as an acute abdomen.…”

“…In these cases, a nephrectomy should be performed immediately assuming that the controlatéral kidney is normal [1,4,7], The high incidence of renal carcinoma among cases of sponta neous rupture of the kidney dictates the need for a careful intraoper ative inspection of the kidney. According to McDougall et al [1] and Novicki et al [21], nephrectomy seems to provide the best chance for recovery in these patients.…”

“…Besides adenocarcinomas, renal tumors that have been reported to bleed spontaneously include papillary carcinoma of the renal pel vis [3], angiomyolipoma [1,[4][5][6][7], angiosarcoma [8], adenoma [9], fibromyoma [10], fibroxanthoma [11] and Wilms' tumors [1], This case refers to a renal cell sarcomatous carcinoma co-expressing both cytokeratin and vimentin and presenting as spontaneous retroperi toneal hemorrhage.…”