Spontaneous Perirenal Hemorrhage in End-Stage Renal Disease Treated with Selective Embolization

Abstract

Spontaneous nontraumatic rupture of the kidney (Wunderlich syndrome) is an extremely uncommon condition on hemodialysis. We report a case of 44-year-old hemodialysis patient presented with hemorrhagic shock and a right quadrant abdominal pain to the emergency department. There was no history of trauma. A kidney rupture was revealed by abdominal computed tomography, and active bleeding was successfully managed with arterial embolization. This case illustrates the safe and successful application of interventional radiology in the management of nontraumatic renal hemorrhage in the specific group of hemodialyzed patients even in the emergency setting.

Wunderlich syndrome (spontaneous renal hematoma) as a cause of acute abdomen: a case report

“…The management with arterial embolization allows to treat patients with a neoplasic cause, in any cases being the definitive treatment. 13 The surgical management in the past was preferred due to high incidence of neoplasic cause in SRH, it actually has been replaced by spectating and the minimal invasion management. 3 The World society of emergency surgery (WSES) and the American association for surgery of trauma (AAST) recommend the management with angioembolization in cases of expansive perirrenal hematoma.…”

Spontaneous perirenal hemorrhage in hemodialysis patient treated with selective embolization: A case series and review of the literature

“…Sometimes, it might be misdiagnosed as a renal tumor or an evolving abscess. 27,28 In 2007, Moore AE reported a case of spinal cord ischemia as a complication of embolization procedures. It gives valuable information regarding the cause of hematoma.…”

“…5,26 With the improvement of vascular surgery, selective renal angiography with transcatheter embolization using various embolic materials is increasingly performed and may represent the ideal minimally invasive therapeutic approach for SPH. 27,28 In 2007, Moore AE reported a case of spinal cord ischemia as a complication of embolization procedures. 27 Now with the use of new microvascular catheters and microcoils, the technique is more refined and is associated with lesser iatrogenic morbidity.…”

Selective Renal Arterial Embolization in the Treatment of Hemodialysis Patients Complicated With Wünderlich Syndrome: A Case Report

“…Conservative treatment can be performed under close monitoring if the bleeding is not serious or not caused by a tumor (7). Embolization in dialysis patients with spontaneous renal hemorrhage is rarely reported in the literature (8). To minimize unnecessary surgical trauma and bleeding risk, blind surgical exploration, which is traditionally performed, should not be considered if the patient's general health condition is good or the cause of the hemorrhage is unclear (9,10).…”