Title: Wunderlich syndrome – a rare cause of hypovolemic shock – Case Report

Abstract:

Retroperitoneal  haemorrhage (Wunderlich  syndrome) is a  rare cause of hypovolemic shock in emergency patients;  however,  it is  associated  with a high morbidity and presents  a diagnostic  challenge in the Emergency Department. It is  more common  in female patients  older  than  50  years, and one of the leading causes is a benign renal  tumour angiomyolipoma (AML). Angiomyolipoma predominantly affects only one kidney. Bilateral  AML is  strongly associated  with a rare autoimmune disorder-tuberous sclerosis  and occur  in  80%  of  cases  of  TS.  Symptoms  caused  by  growing  renal  AML  are  absent  to  mild  and  non-specific  (intermittent  loin,  lower  back pains, haematuria). Rupture with  retroperitoneal  bleeding is a frequent complication  of AML and occurs  in 20%  of all  cases. Initial presentation of retroperitoneal haemorrhage is remarkably similar to a ruptured abdominal aortic aneurysm (AAA). Most  of the cases remain  clinically silent  during the growth  phase and present to the hospital  with  a  complication  in the form of retroperitoneal  bleeding. Risk of bleeding  increases with  the size  of the tumor and AML bigger than  4cm are treated with  selective embolization if  found on routine scanning. Many cases  of  AML are diagnosed  when  a patient  is  being scanned  for  other  medical problems. Even in an emergency when AML ruptures  is still  possible to treat it either  with selective embolization or  selective nephrectomy, and the majority of patients are making a successful recovery. Keywords:  Wunderlich  Syndrome (Retroperitoneal Haemorrhage); Renal Angiomyolipoma  (AML); Loin Pain  with  Haematuria; Hypovolemic Shock; Selective Embolization.

Biography:

Jaroslaw Nowacki currently works in Urgent Care Centre, Queen Mary’s Hospital Sidcup, Hurley Medical Group