Diagnosis and management of Wunderlich syndrome / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the causes,diagnosis and management of Wunderlich syndrome. Methods A total of 19 cases (15 men and 4 women) of Wunderlich syndrome were reported.Their average age was 47 years (range,11-75 years).Imaging examinations (B-ultrasound,IVU,CT,arteriography,MRI) together with laboratory testing and history supported the etiologic diagnosis of tumorous disease (n=10),non-tumorous disease (n=7) and unknown causes (n=2).Surgical management was performed in 9 cases of kidney tumor and 1 of ureter stone with obstructive hydronephrosis.Conservative treatment was adopted in the rest 9 cases.In 2 of the conservatively treated cases,the bleeding artery was embolized because of persistent bleeding. Results In the 9 tumor cases undergoing surgery,pathology confirmed renal cell carcinoma in 7,malignant fibrous histocytoma in 1 and transitional cell carcinoma of the renal pelvis in 1.These 9 cases all recovered after operation and experienced follow-up for 6 months to 3 years.Of them,5 cases died of tumor recurrence and metastasis;3 survived disease-free for 9 months to 2 years;1 had liver metastasis 1 year after operation and survived with tumor for 11 months.One case of ureter stone got significant improvement.The 9 cases undergoing conservative treatment had satisfactory results. Conclusions The main cause of Wunderlich syndrome is renal tumor.The conservative approach appears to be the most acceptable option for the patients with Wunderlich syndrome who have no malignant tumorous cause.