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Abstract Wunderlich syndrome, or spontaneous renal hemorrhage (SRH), is a rare condition encountered in patients undergoing chronic hemodialysis (HD) usually attributed to acquired cystic kidney disease (ACKD) among other causes. In the literature, colonoscopy is associated with splenic injuries, and renal hemorrhage has not been previously described. Management can range from conservative treatment to angiographic embolization or exploration and nephrectomy. Here we report an unusual case of a 54-year-old woman HD patient who presented with SRH within a few days of colonoscopy. The reason of SRH was rupture of an ACKD cyst. We assumed that colonoscopy was a provoking factor and elaborated hypotheses for its etiopathogenesis. The patient underwent successful left nephrectomy. The importance of this case lies in the fact that colonoscopy is not always an innocent procedure in HD patients, and could be complicated by renal cyst hemorrhage.
Resumo A síndrome de Wunderlich, ou hematoma perirrenal espontâneo (HPE), é uma condição rara encontrada em pacientes submetidos à hemodiálise crônica (HD) geralmente atribuída à doença renal cística adquirida (DRCA), entre outras causas. Na literatura, a colonoscopia está associada a lesões esplênicas, e o hematoma renal não foi descrito anteriormente. O manejo pode variar de tratamento conservador a embolização angiográfica ou exploração e nefrectomia. Aqui relatamos um caso incomum de uma paciente em HD de 54 anos de idade que se apresentou com HPE dentro de poucos dias após a colonoscopia. O motivo do HPE foi a ruptura de um cisto de DRCA. Consideramos que a colonoscopia foi um fator provocador e elaboramos hipóteses para sua etiopatogenia. A paciente foi submetida a uma nefrectomia esquerda bem-sucedida. A importância deste caso reside no fato de que a colonoscopia nem sempre é um procedimento inocente em pacientes em HD, e pode ser complicada por hemorragia do cisto renal.
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A 55-year-old woman with fever and consciousness disorder diagnosed as infective endocarditis was transported to our hospital. She had atopic dermatitis. A mobile vegetation at the mitral valve was revealed by the transesophageal echocardiography, and a computed tomography (CT) scan showed cerebral infarction, left renal infarction and suspected embolization of the vegetation. Streptococcus aureus was detected in the blood culture test. We conducted emergent surgery, mitral valve plasty was performed. On the second day after the operation, the hemoglobin began to decrease, and the hemodynamics became unstable. The contrast CT examination revealed arterial bleeding from the left kidney, which had an infarction before the operation. We performed emergent catheter liquid embolization for the superior polar branch of the left renal artery, and the hemodynamics improved thereafter. There has been no report of renal hemorrhage after cardiac surgery for infective endocarditis. This case reminded us that cardiac surgery for infective endocarditis may cause various complications of organs.
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Objective:To evaluate the efficacy of super-selective renal artery embolization (SRAE) in the treatment of patients with traumatic renal hemorrhage who failed to respond to conservative treatment.Methods:A total of 64 patients with traumatic renal hemorrhage admitted to Wenling First People′s Hospital from May 2018 to May 2020 were selected as the study subjects. All patients were treated with SRAE, the clinical efficacy, angiographic performance, renal function, complications, postoperative blood transfusion rate and renal retention rate of the patients were observed.Results:There were 62 cases among 64 cases with traumatic renal hemorrhage were successfully embolized once, with a success rate of 96.88%(62/64). By angiography, 46.88%(30/64) of the patients had pseudoaneurysms, 29.69% (19/64) had renal arteriovenous fistula, 9.38% (6/64) had pseudoaneurysms complicated with renal arteriovenous fistula and 14.06% (9/64) had contrast extravasation. Bleeding points were observed in all patients, and the proportions of 1 bleeding point, 2 bleeding points and 3 bleeding points were 73.44%(47/64), 20.31% (13/64) and 6.25% (4/64), respectively. The proportions of upper, middle and lower bleeding points were 18.75% (12/64), 37.50% (24/64) and 43.75% (28/64). On the 7th day after the surgery, the levels of hemoglobin (Hb) and haematocrit (Hct) were higher than those before surgery: (91.79 ± 23.58) g/L vs. (90.45 ± 22.31) g/L, 0.272 ± 0.070 vs. 0.262 ± 0.068; the level of serum creatinine (SCr) was lower than that before surgery: (82.97 ± 25.32) μmol/L vs. (84.57 ± 24.51) μmol/L, the differences were statistically significant ( P<0.05). The total incidence of postoperative complications was 26.56% (17/64). The renal retention rate was 100.00% (64/64) and the proportion of blood transfusion patients was 39.06% (25/64). Conclusions:SRAE can play a good hemostatic effect in patients with traumatic renal hemorrhage that failed to respond to conservative treatment. It is safe and reliable with a low incidence of complications, and can better protect renal tissue function.
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A 72-year-old male patient with a history of polycystic kidney disease and lung malignancy underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the evaluation of tumor recurrence. The FDG PET/CT and subsequent non-enhanced CT scans revealed a hemorrhage in the peri-renal space of the left original kidney. Interesting in this case was the incidental detection of unexpected peri-renal hemorrhage during an oncologic assessment with FDG PET/CT.
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Aged , Humans , Male , Electrons , Hematoma , Hemorrhage , Kidney , Lung , Polycystic Kidney Diseases , Positron Emission Tomography Computed Tomography , Recurrence , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the clinical application of interventional combination embolization of spleen and kidney in treating traumatic splenic and renal hemorrhage. Methods Since Jan. 2010 to early 2014, a total of 24 patients with traumatic splenic and renal hemorrhage were admitted to authors’ hospital. After angiography, super-selective embolization with Gelfoam particles was employed to occlude the bleeding arteries. The results were analyzed. Results Technical success with single procedure was achieved in all the 24 patients. All 24 patients survived the trauma. The complication was mild. Follow-up examination showed that the embolization results were perfect. Conclusion For the treatment of traumatic splenic and renal hemorrhage, interventional combination embolization of spleen and kidney is safe and effective with reliable clinical results, and this technique can reduce visceral function damage to the greatest possible advantage.
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Objective To prospectively investigate superselective renal arterial embolization (SRAE) in the treatment of iatrogenic renal hemorrhage MethodsFrom November 2005 to November 2010,19 patients with iatrogenic renal hemorrhage in the Affiliated Hospital of Hangzhou Normal University underwent diagnostic renoarteriography to reveal the site and degree of renal artery rupture,then superselective embolization by coins,or coins combined with spongia gelatinosa were performed for these patients.Results Renal arteriography showed hemorrhage was located at the renal segmental arteries and/ or their branches ( 9 cases at segmental renal artery,6 cases at interlobar artery and 4 cases at arciform artery),two cases were found with simple hemorrhage of segmental renal artery ( SRA ),9 cases with pseudoaneurysm,5 cases with arterio- venous fistula (AVF),3 cases with pseudoaneurysm combined with AVF.Seventeen cases received embolization with coins,while 2 cases with pseudoaneurysmes received embolization with coins and spongia gelatinosa at the same time.Bleeding was successfully ceased immediately and did not recur in all cases.Conclusions Superselective renal arterial embolization could be considered as a safe and effective method to treat hemorrhage of iatrogenic renal vascular injuries..
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Objective To evaluate super-selective renal arterial embolization(SRAE)in treating severe renal hemorrhage when conservative treatment had failed. Methods SRAE was performed in 111 patients with severe renal hemorrhage who had failed to respond the conservative management.The clinical data,the way of embolization,the medication and the follow-up findings were retrospectively analyzed.Results Excellent results were obtained in all patients after SRAE and no serious complications occurred.The technical successful rate with single session was 95.5%(106/111).Gross hematuria disappeared within 1-4 days after the treatment.Two patients developed shock after renal embolization and had to receive surgery after the shock was controlled.Three patients had a recurrence of hematuria,the blood urine subsided after SRAE was employed again.A follow-up with a mean period of 37.4 months was carried out in 92 patients,and the follow-up checkups showed that the renal function was well preserved in all patients.Conclusion Super-selective renal artery catheterization and embolization is a safe and effective treatment for severe renal hemorrhage,it can maximally preserve the healthy renal parenchyma as well as the renal function.Therefore,this technique should be regarded as the treatment of first choice for patients with severe renal hemorrhage.
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Objective To investigate the value of interventional therapy for nephrorrhagia after mini-invasive percutaneous nephrolithotomy(MPCNL).Methods From February 2007 to December 2008,16 cases with nephrorrhagia after MPCNL underwent interventional therapy,of them,14 cases treated with super-selective embolization,one case treated by kindey arterial embolization and one case with renal subcapsular bleeding treated by reptilase intra-arterial infusion.Results In 16 cases,15 cases were successfully treated by embolization.Conclusion Interventional therapy is the first choice method for treating nephrorrhagia after MPCNL.
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Objective To discuss the prevention and treatment of hemorrhage during or after minimally invasive percutaneous nephrolithotomy (PCNL). Methods Clinical data of 12 cases of hemorrhage during or after minimally invasive percutaneous nephrolithotomy from July 2005 to October 2005 in this hospital were retrospectively analyzed. Results Intraoperative hemorrhage occurred in 10 cases. The bleeding was stopped by pressure in 6 cases and a re-operation of open nephrolithotomy 5 days later was required in 4 cases. Postoperative hemorrhage was seen in 2 cases. The bleeding was successfully stopped by endoscopic electrocoagulation in 1 case and by interventional highly-selected embolization on the 4th day after operation in 1 case. Conclusions Prevention should be put first for hemorrhage during or after minimally invasive percutaneous nephrolithotomy. Accurate puncture and skillful tunnel expansion are the key to minimize the hemorrhage. Interventional embolization should be the first choice in case of massive or repeated bleeding.
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We report a patient with autosomal dominant polycystic kidney disease(ADPKD) undergoing maintenance hemodialysis who underwent transcatheter arterial embolization(TAE) of the renal arteries to control the persistent renal hemorrhage. In 1991, the patient had been diagnosed as having ADPKD by computed tomography(CT) of abdomen. In 1997, the patient started hemodialysis. In October 2000, she was admitted to our hospital because of gross hematuria and both flank pain. Abdominal CT showed marked enlargement of the bilateral kidneys with numerous cysts. Renal angiography using the Seldinger technique showed stretched and deformed segmental renal arteries without active bleeding. Renal hemorrhage was continued despite of medical treatment. TAE with stainless steel coils was performed on both renal arteries. Renal bleeding was stopped immediately after TAE and anemia was improved and stabilized thereafter. Follow-up CT after five months later TAE showed the marked decrease in size of both kidneys, and patient's abdominal symptoms were disappeared too. This report shows that TAE is a safe and effective therapy for ADPKD patients with persistent renal bleeding refractory to medical therapy.