Does spontaneous renal hemorrhage mandate close surveillance for impending renal cell carcinoma? A case report and literature review

Aldughiman, Abdullah W.; Alsunbul, Abdulrahman; Al-Gadheeb, Abdullah; Almuaiqel, Muaiqel; Alzahrani, Ahmad; Alzahrani, Tarek; Alghamdi, Abdullah; Alakrash, Hamad

doi:10.1016/j.ijscr.2020.06.067

Cited by 6 publications

(8 citation statements)

References 7 publications

(11 reference statements)

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“…Contrast-enhanced CT helps differentiate the various causes of kidney rupture and the extent of bleeding [ 21 ]. When patients have contraindications to contrast-enhanced CT, such as allergy to contrast agents or renal insufficiency, magnetic resonance imaging (MRI) can be used as an alternative to detect small renal tumors after the acute bleeding phase has subsided [ 22 ] and to detect hemorrhagic cysts [ 23 ]. However, MRI cannot be widely used in emergencies because of its long scan times and low utilization rates.…”

Section: Discussionmentioning

confidence: 99%

Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series

Tao,

Zhang,

Zhang

et al. 2024

Am J Case Rep

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Case series Patients: Female, 44-year-old • Female, 56-year-old • Male, 45-year-old Final Diagnosis: Wünderlich syndrome Symptoms: Flank pain Clinical Procedure: — Specialty: Urology Objective: Rare disease Background: Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. Case Reports: Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. Conclusions: These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.

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Section: Discussionmentioning

confidence: 99%

Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series

Tao,

Zhang,

Zhang

et al. 2024

Am J Case Rep

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“…Currently, no guidelines for WS management exist. 6 Treatment should rely on anticoagulation discontinuation/reversal, immediate fluid resuscitation and angioembolization or emergent nephrectomy in clinically deteriorating patients. 6 Due to scarcity of cases, optimal management is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…6 Treatment should rely on anticoagulation discontinuation/reversal, immediate fluid resuscitation and angioembolization or emergent nephrectomy in clinically deteriorating patients. 6 Due to scarcity of cases, optimal management is controversial. While some urologists favour early exploratory surgery or selective arterial embolization, others may prefer a more conservative approach.…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report

et al. 2022

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Wunderlich syndrome is a rare and possibly life-threatening haemorrhagic syndrome presenting as spontaneous nontraumatic renal rupture with subcapsular and perinephric haemorrhage. Apixaban, a direct oral anticoagulant recommended in patients with atrial fibrillation, has previously been associated with atraumatic solid organ rupture but, to date, no case of apixaban-related Wunderlich syndrome has been reported. We report a rare case of Wunderlich syndrome associated with apixaban while addressing the difficulties face by clinicians when managing anticoagulation in bleeding patients.

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“…Bolesnici se mogu prezentirati Lenkovom trijadom ili kao akutni abdomen. Kompjutorizirana tomografija s kontrastom smatra se zlatnim standardom za dijagnostiku te ona može dati detaljniji uvid u krvarenje i njezin uzrok 4 . Angiografijom se može potvrditi krvarenje te se istodobno može i liječiti (embolizacija).…”

Section: Raspravaunclassified

Wunderlichov sindrom kao prva manifestacija karcinoma bubrega

Radoš,

Markić

2023

Med. Flum. (Online)

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Cilj: Prikazati bolesnika u kojeg je maligna neoplazma bubrega uzrok Wunderlichovog sindroma i ukazati na važnost prepoznavanja Wunderlichovog sindroma u kliničkoj praksi. Wunderlichov sindrom označava pojavu akutnog, netraumatskog, spontanog krvarenja u supkapsularni ili perirenalni prostor. Prikaz slučaja: Na hitni bolnički prijam primljen je muškarac s bolovima u lijevom dijelu abdomena, praćenih mučninom i vrtoglavicom te jednom tamnijom stolicom. Fizikalnim pregledom nije pronađen nikakav patološki nalaz, ali ultrazvučnim pregledom ustanovljena je veća perirenalna kolekcija. Daljnjom obradom, uključujući i kompjutoriziranu tomografiju, utvrđena je tvorba na gornjem polu lijevoga bubrega, kao i opsežniji perirenalni hematom. Pacijentu je učinjena hitna nefrektomija te evakuacija perirenalnog hematoma. Patohistološki nalaz potvrdio je kako se radi o karcinomu bubrega (svjetlostanični tip) koji je rupturirao. Dvije godine kasnije, pacijent se ponovno javio u hitni bolnički trakt radi teške parapereze. Magnetska rezonancija pokazala je koštane metastaze u području torakalne kralježnice s širenjem u spinalni kanal. Pacijentu je hitno učinjena laminektomija uz redukciju tumora u spinalnom kanalu. Imunohistokemijskim bojenjima dokazano je da se radi o metastazama karcinoma bubrega. Pacijent je upućen na daljnje onkološko liječenje. Zaključak: Wunderlichov sindrom iznimno je rijetka pojava u urološkoj praksi, ali treba biti uključen u diferencijalnu dijagnozu kod pacijenata koji se javljaju s bolovima u lumbalnoj regiji, palpabilnom tvorbom i znakovima šoka. Sindrom je etiološki najčešće vezan uz benigne neoplazme bubrega, ali može biti posljedica malignih novotvorina kao kod našeg bolesnika.

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Does spontaneous renal hemorrhage mandate close surveillance for impending renal cell carcinoma? A case report and literature review

Cited by 6 publications

References 7 publications

Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series

Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series

Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report

Wunderlichov sindrom kao prva manifestacija karcinoma bubrega

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