Wunderlich syndrome in pregnancy and the puerperium: A case presentation and literature review

Abstract

Wunderlich syndrome, also known as spontaneous retroperitoneal hematoma, is a rare complication of varied etiology. Fifty percent of cases are associated with renal angiomyolipoma. The most common symptom is abdominal pain, and Lenk’s triad is seen in 20% of patients, which consists of abdominal pain (67%), palpable abdominal mass (54%), and hypovolemic shock (26%). The diagnostic study of choice is abdominal tomography with intravenous contrast medium. However, angiography has diagnostic and therapeutic usefulness in patients that are candidates for angioembolization. The treatment of choice depends on the clinical status of the patient, presentation of the pathology, and in some cases, previous kidney function. In the majority of cases, treatment is nephrectomy, but successful management through partial nephrectomy or selective angioembolization has been described in selected patients with insidious disease progression, hemodynamic stability, and involvement of both kidneys, among others.

We present herein the case of a 19-year-old female, who in her first days of physiologic puerperium, came to the emergency room because of abdominal pain and gross hematuria. Abdominal ultrasound revealed a heterogeneous lesion on the right kidney. An abdominal computed axial tomography scan with intravenous contrast medium identified an image suggestive of a right renal hematoma. Due to the patient’s sudden hemodynamic decline, right nephrectomy was performed. The pathology study ruled out the presence of angiomyolipoma or other neoplasia or abnormal condition in the surgical specimen.