Wunderlich syndrome: Rare and unrecognized emergency

Larbi, Hamedoun; Hassan, Ilias; Cherraqi, Amine; saouab, Rachida; Alami, M.; Ameur, A.

doi:10.1016/j.eucr.2022.102093

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…Ultrasound is a quick, safe, and inexpensive method for diagnosing diseases. Although it is not suitable for determining the etiology, it can be used as a follow-up method to assess the recovery of hematoma [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The primary management strategies for WS include conservative treatment, vascular embolization, and surgery (radical or partial nephrectomy). In patients with stable vital signs and no detectable malignancy or large AML on the initial CT scan, conservative management with close monitoring can be used [ 23 , 24 ], but it cannot identify the cause of the disease, which can cause patient anxiety. Additionally, renal function should be closely monitored during follow-up.…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…A meta-analysis of 165 patients found that only 6.7% had no aetiological basis for their bleeding 15. Case studies of Wunderlich syndrome without malignancy or vascular risk factors include presentations precipitated from coagulopathy secondary to snakebite envenomation, therapeutic anticoagulation, from pyelonephritis or, often, idiopathic 16–20…”

Section: Discussionmentioning

confidence: 99%

“…Other options for management include transarterial embolisation (TAE) using microcoils; however, one study showed that 15% of the patients who underwent TAE had to progress to full nephrectomy 19. Increasingly, case studies indicate conservative management with volume resuscitation via blood product transfusion and fluids, analgesia and bed rest can be used as a less invasive first line, mirroring management of renal trauma; however, a proportion of these patients go on to need invasive management 14 20…”

Section: Discussionmentioning

confidence: 99%

“…First, patients receive heparin during each dialysis session; on average, three times a week. Additionally, there is a clear link between uraemia and impaired platelet aggregation and damaged platelet-vessel wall interactions 20. Furthermore, it is estimated that over half of HD-dependent patients have coexisting cardiovascular disease, for which antiplatelets are both primary and secondary treatment 21.…”

Section: Discussionmentioning

confidence: 99%

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Wünderlich’s syndrome in a haemodialysis patient

Wood,

Ismail

2023

BMJ Case Rep

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Wünderlich’s syndrome, or spontaneous renal haemorrhages, are rare, atraumatic, intraparenchymal and perirenal haemorrhages, which are difficult to diagnose and can be potentially fatal.Patients who are dialysis-dependent are at an increased risk of bleeding, due to an association between uraemia and platelet dysfunction; for this reason, the use of double antiplatelets is avoided in this cohort. Case studies exist demonstrating spontaneous bleeds in these patients.Fish oil is used increasingly within medicine: however, it is known to interfere with platelet aggregation, therefore, theoretically increasing the tendency to bleed. The topic remains under debate, with systemic reviews refuting a correlation between intraoperative and postoperative bleeding and fish oil consumption. There is, however, an absence of literature on the adverse effects of fish oil when taken in large quantities.This case study explores the case of a patient who had a spontaneous renal bleed following a large, self-medicated dose of fish oil.

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Transarterial embolization in Wunderlich syndrome due to recanalization of giant renal angiomyolipoma pseudoaneurysm: a case report and literature review

Koesbandono,

Sidipratomo,

Utomo

et al. 2024

Egypt J Radiol Nucl Med

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Background Acute spontaneous bleeding from renal angiomyolipoma (AML) is one of the causes of Wunderlich syndrome, a rare and potentially fatal clinical condition. Clinical deterioration will occur if there is a delay in urgent management. There are several management options for renal angiomyolipoma rupture. However, until now little is known about the case of recanalization from post-coil embolization of renal angiomyolipoma. There is no guideline about embolization technique for the management of recurrent bleeding after embolization or coil recanalization of renal angiomyolipoma. Case presentation A 55-year-old male has Wunderlich syndrome caused by recurrent bleeding of giant AML of the left renal due to coil recanalization compounded by a pseudoaneurysm and other bleeding site in bilateral giant renal angiomyolipoma which is showed by contrast-enhanced abdominal computed tomography scan. The patient underwent urgent transarterial embolization and some blood transfusion. Clinical improvement occurred and the patient discharged several days later. Conclusions Embolization for spontaneous bleeding or rebleeding of renal pseudoaneurysms may become the first choice of treatment in bilateral multiple renal angiomyolipoma rather than other managements which are available to preserve renal function.

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Wunderlich syndrome: Rare and unrecognized emergency

Cited by 5 publications

References 3 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

Wünderlich’s syndrome in a haemodialysis patient

Transarterial embolization in Wunderlich syndrome due to recanalization of giant renal angiomyolipoma pseudoaneurysm: a case report and literature review

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