[Non-traumatic spontaneous retroperitoneal bleeding: the effect of an early and accurate diagnosis]

Abstract

Background: Spontaneous sub-capsular or peri-renal haemorrhage (Wunderlich syndrome) is a rare condition that involves a diagnostic challenge. In many cases, bleeding leads to haemodynamic instability that may be life threatening. Therefore, it is important to have a high clinical suspicion for timely action.

Objective: This paper highlights the experience of the Urology Department of the Western National Medical Center of the Mexican Institute of Social Security.

Methods: Retrospective study of consecutive non-randomized sampling. The Emergency Service Registry was reviewed for all admissions from 1 January 2010 to 31 December 2013 to identify patients with non-traumatic spontaneous retroperitoneal haemorrhage. Patient charts were reviewed to determine sex, age, vital signs, laboratory and imaging results, associated diseases, management, and outcomes.

Results: A total of 11 patients met the inclusion criteria for the study. All patients were received in the Emergency Department referred from secondary care hospitals. None of them were referred with a diagnosis of spontaneous retroperitoneal haemorrhage. The diagnosis was made in 100% of patients with abdominal CT scan. All patients received urgent surgical management on the day of admission due to haemodynamic instability. Ten patients underwent nephrectomy. Histopathological findings included, among others, angiomyolipoma, renal carcinoma, and metastatic hepatocellular injury.

Conclusions: Spontaneous retroperitoneal haemorrhage is a lethal condition if not detected on time. The abdominal CT scan is the most accurate diagnostic method for detection. Surgical management is necessary in patients with haemodynamic instability.

Keywords: Abdominal computed tomography scan; Carcinoma renal; Hemorragia retroperitoneal espontánea; Hemorragia retroperitoneal no traumática; Non-traumatic renal haemorrhage; Renal carcinoma; Spontaneous sub-capsular or peri-renal haemorrhage; Síndrome de Wunderlich; Tomografía computada; Wunderlich syndrome.