Intraoperative cell salvage in the treatment of Wunderlich syndrome caused by renal angiomyolipoma

Abstract

Introduction. Wunderlich syndrome is defined as acute spontaneous hemorrhage into the subcapsular and perirenal spaces in the absence of trauma. The most common causes of Wunderlich syndrome are various renal neoplasms, polycystic and vascular kidney diseases. Wunderlich syndrome is common in patients who use anticoagulant therapy or suffer from various types of congenital coagulopathies. The clinical diagnosis is usually confirmed by computer tomography of the abdomen and requires urgent surgical treatment or renal artery embolization. Case Report. A 45-year-old woman was admitted to the Emergency Center due to acute pain in the left abdomen, associated with arterial hypotension. A computer tomography of the abdomen was performed using intravenous contrast, which showed a ruptured tumor of the left kidney with a massive retroperitoneal hematoma. The tumor was 7 cm in diameter and according to the computer tomography data it corresponded to an angiomyolipoma. The patient underwent emergency surgery. Intraoperative cell salvage was used with additional blood replacement. Nephrectomy and drainage of the massive retroperitoneal hematoma were performed. Pathohistological analysis of the surgically removed kidney confirmed a renal angiomyolipoma. Conclusion. Wunderlich syndrome caused by the rupture of angiomyolipoma is still a life-threatening condition that should be considered in the differential diagnosis of sudden abdominal pain, especially in women of reproductive age. In hypotensive patients, available radiological methods should be used to make an accurate diagnosis, before taking the patient to the operating room.