Spontaneous Rupture of Renal and Ureteral Tumors Presenting as Acute Abdominal Condition

Abstract

We report on 3 patients who presented with an acute onset of abdominal pain, a palpable abdominal mass and a rapid decrease in hemoglobin. In 2 patients a spontaneously ruptured hypernephroma was found and the other patient had a squamous cell carcinoma of the ureter with bleeding into the tumor. Although in all 3 cases the tumors were at an advanced stage of development, the patients had been entirely free of urological symptoms until shortly before hospitalization. The importance of considering the possibility of spontaneous rupture of such a tumor in the evaluation of cases of an acute abdomen is stressed.

Diagnostic and Therapeutic Dilemmas in Nontraumatic Spontaneous Perirenal Hemorrhage

“…Today With ultrasound becoming widely available, it should be con sidered as the examination of choice in the differential diagnosis of unclear acute abdominal disorders. CT scan confirms the diagnosis and in some cases can reveal the cause of the rupture [2,3]. Nevertheless, in most of our cases, CT scan was unsuccessful in determining the cause of the renal rupture because of the large amount of peri nephric hematomas present.…”

“…The clinical picture usually includes the classic 'Lenk's triad' consisting of acute flank pain, tenderness and symptoms of internal bleeding [2], a picture that was present in all our 8 cases. Diagnosis depends on the clin ical picture and radiological investigations.…”

“…It is characteristic that we treated 8 cases in the last 6 years, while in the same period we treated 58 cases of renal trauma. The cause is always a congenital or acquired kidney lesion [1], the commonest being renal tumor [2], cystic lesions and hydronephrosis. Acute rise of renal vein pressure was considered by Polkey and Vynalek [7] as the mechanism responsible for parenchymal rupture.…”

“…Besides adenocarcinomas, renal tumors that have been reported to bleed spontaneously include papillary carcinoma of the renal pelvis [1,2], angiomyolipoma [3,4], angiosarcoma [5], adenoma and Wilm's tumors [1],…”

Sarcomatous Carcinoma of the Kidney Presenting as Spontaneous Retroperitoneal Hemorrhage

“…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.…”