scholarly journals 284 Wunderlich Syndrome - Case Report of a Surgical Emergency Due to Spontaneous Non-Traumatic Retroperitoneal Haemorrhage

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Patil ◽  
P Prakash Narayan ◽  
J Henderson
Keyword(s):  
Hypovolemic Shock ◽  
Arterial Embolization ◽  
Rare Condition ◽  
Sudden Onset ◽  
Haemodynamic Instability ◽  
Renal Angiomyolipoma ◽  
Successful Management ◽  
Selective Embolization ◽  
Acute Flank Pain ◽  
Retroperitoneal Haemorrhage

Abstract A 42-year-old female with no other significant co-morbidities presented with complaints of sudden onset abdominal pain, she was in state of shock- her haemoglobin dropped drastically to 6.8g/dl from 11.8g/dl. She was resuscitated and was given blood transfusion. CT Scan was suggestive of retroperitoneal haemorrhage due to rupture of Renal angiomyolipoma (RAML). Patient underwent selective embolization of renal artery the next day and was discharged after 3 days of post-operative stay. Wunderlich Syndrome-is a rare condition in which spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces is most commonly caused due to spontaneous rupture of RAML.It is characterized by Lenk’s triad – Acute flank pain, flank mass, hypovolemic shock. Size of AML (>4 cm), prothrombotic states such as pregnancy are main causes of AML rupture. Patients are managed conservatively or with help of selective arterial embolization. Nephrectomy is last resort in a hemodynamically unstable patient or in cases of embolization failure. When dealing with acute abdomen with haemodynamic instability in non-traumatic cases it is essential to consider possibility of Wunderlich Syndrome. Early diagnosis, availability of Interventional radiology is key to successful management and potentially avoiding a Nephrectomy.

scholarly journals Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma: a case report

2019 ◽  
Vol 47 (2) ◽  
pp. 1059-1063
Author(s):  
Ganghong Chen ◽  
Jing Yang ◽  
Guangyu Qian ◽  
Kexiang Jiang ◽  
Yanting Lv ◽  
...  
Keyword(s):  
Case Report ◽  
Spontaneous Rupture ◽  
Splenic Artery ◽  
Hypovolemic Shock ◽  
Artery Aneurysm ◽  
Rare Condition ◽  
Sudden Onset ◽  
Epithelioid Hemangioendothelioma ◽  
Splenic Artery Aneurysm ◽  
Quadrant Pain

Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma is a rare condition. Splenic artery aneurysm can be complicated by rupture resulting in hypovolemic shock, which can be fatal if not treat properly. We report a case of a 50-year-old man who presented with sudden onset of left upper quadrant pain and shock. This patient underwent splenectomy with distal pancreatectomy. His pathological diagnosis showed splenic epithelioid hemangioendothelioma.

scholarly journals Urgent Transcatheter Arterial Embolization for Wunderlich Syndrome With Hypovolemic Shock Secondary to Ruptured Renal Angiomyolipoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Maofeng Gong ◽  
Zhengli Liu ◽  
Haobo Su ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
...  
Keyword(s):  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Hypovolemic Shock ◽  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Technical Success ◽  
Embolic Agents ◽  
Nontarget Embolization ◽  
Glubran 2 ◽  
Embolic Materials

Purpose: Wunderlich syndrome (WS) with hypovolemic shock secondary to ruptured renal angiomyolipoma (rAML) represents an urgent condition. Hence, we reported our experience with transcatheter arterial embolization (TAE) using different embolic materials under this condition.Methods: This retrospective study consisted of 22 patients. Embolic materials including particles, microcoils, and liquid embolic agents were selectively used based on the decisions of interventional radiologists. Technical success was defined as the complete occlusion of bleeding vessels on the final renal angiogram. Clinical success was defined as the absence of re-hemorrhage needed for repeat endovascular or surgery treatment after TAE.Results: The articulated materials were used when WS presented without aneurysms; a combination of particulate materials and microcoils or Glubran 2 alone were used for WS with aneurysms. The technical success based on 24 episodes of TAEs in 22 patients was 100% (24 of 24). Repeat TAE was achieved in two patients with hemorrhages re-occurring two days after the initial embolization with microcoils alone. The clinical success was 90.9% (20 of 22). No nontarget embolization or embolization-related complications occurred during the TAE procedure. Of the patients, 27.3% (6 of 22) experienced minor complications of post-embolization syndrome (PES). During a median follow-up time of 34 months, no recurrent hemorrhage that required repeat endovascular or surgical treatment for hemostasis occurred.Conclusion: Urgent TAE with the selective use of different embolic materials is an effective alternative to control WS with hypovolemic shock secondary to ruptured rAML. The condition of presenting with or without aneurysms may determine the embolic materials employed.

scholarly journals Selective arterial embolization for a high-flow priapism following perineal trauma in a young gymnast

2018 ◽  
Vol 90 (3) ◽  
pp. 218-219
Author(s):  
Grazia Bianchi ◽  
Camilla Sachs ◽  
Irene Campo ◽  
Giovanni Liguori ◽  
Carlo Trombetta
Keyword(s):  
Pediatric Patients ◽  
Corpus Cavernosum ◽  
Arterial Embolization ◽  
Rare Condition ◽  
High Flow ◽  
Perineal Trauma ◽  
Internal Pudendal Artery ◽  
Selective Embolization ◽  
Selective Arterial Embolization ◽  
The Right

Introduction. High-flow priapism is a rare condition in children, usually due to a perineal trauma. Materials and methods. We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. Results. A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. Conclusions. Selective arterial embolization is a safe treatment that can also be used in pediatric patients.

scholarly journals Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Asim Rana ◽  
Ahmed F. Mady ◽  
Nagesh Jakaraddi ◽  
Shahzad A. Mumtaz ◽  
Habib Ahmad ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Multislice Ct ◽  
Management Plan ◽  
Haemodynamic Instability ◽  
Renal Angiomyolipoma ◽  
Retroperitoneal Haematoma ◽  
Best Management ◽  
Renal Aneurysm ◽  
Arterial Embolisation ◽  
Retroperitoneal Haemorrhage

Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy.

Renal Angiomyolipoma: Superselective Arterial Embolization and Long Term Follow-up

1997 ◽  
Vol 37 (1) ◽  
pp. 71
Author(s):  
Young Hwan Lee ◽  
Young Min Han ◽  
Chong Soo Kim ◽  
Gyung Ho Chung ◽  
Sang Yong Lee ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Long Term Follow Up

Renal Angiomyolipoma: Long-term Results after Arterial Embolization

2005 ◽  
Vol 16 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Nishita Kothary ◽  
Michael C. Soulen ◽  
Timothy W.I. Clark ◽  
A.J. Wein ◽  
Richard D. Shlansky-Goldberg ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Long Term Results ◽  
Renal Angiomyolipoma

scholarly journals Combination of Superselective Arterial Embolization and Radiofrequency Ablation for the Treatment of a Giant Renal Angiomyolipoma Complicated with Caval Thrombus

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Konstantinos N. Stamatiou ◽  
Hippocrates Moschouris ◽  
Kiriaki Marmaridou ◽  
Michail Kiltenis ◽  
Konstantinos Kladis-Kalentzis ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Transarterial Embolization ◽  
Vena Cava ◽  
Arterial Embolization ◽  
Maximum Diameter ◽  
Renal Angiomyolipoma ◽  
Efficient Treatment ◽  
Extrinsic Compression

This is a case of a 78-year-old male patient with multiple angiomyolipomas of a solitary right kidney. The largest of these tumors (maximum diameter: 13.4 cm) caused significant extrinsic compression of the inferior vena cava complicated by thrombosis of this vessel. Treatment of thrombosis with anticoagulants had been ineffective and the patient had experienced a bleeding episode from the largest right renal angiomyolipoma, which had been treated by transarterial embolization in another institution, 4 months prior to our intervention. Our approach included superselective transarterial embolization of the dominant, right kidney angiomyolipoma with hydrogel microspheres, which was combined, 20 days later, with ultrasonographically guided radiofrequency ablation. Both interventions were uneventful. Computed tomography 2 months after ablation showed a 53% reduction in tumor volume, reduced space-occupying effect on inferior vena cava, and resolution of caval thrombus. Nine months after intervention the patient has had no recurrence of thrombosis or hemorrhage and no tumor regrowth has been observed. The combination of superselective transarterial embolization and radiofrequency ablation seems to be a feasible, safe, and efficient treatment of large renal angiomyolipomas.

scholarly journals Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

2021 ◽  
Vol 10 (18) ◽  
pp. 4062
Author(s):  
François-Victor Prigent ◽  
Kévin Guillen ◽  
Pierre-Olivier Comby ◽  
Julie Pellegrinelli ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Volume Reduction ◽  
Renal Angiomyolipoma ◽  
Cyanoacrylate Glue ◽  
Selective Arterial Embolization ◽  
Before And After ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Postembolization Syndrome

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

scholarly journals Acute Flank Pain, Flank Mass and Hypovolemic Shock due to Kidney Cysts Rupture: An Emblematic Case of Wunderlich Syndrome

2016 ◽  
Vol 2 (2) ◽  
pp. 36-38
Author(s):  
Giovanni Cacciamani ◽  
◽  
Salvatore Siracusano ◽  
Maria Angela Cerruto ◽  
Silvia Bassi ◽  
...  
Keyword(s):  
Hypovolemic Shock ◽  
Flank Pain ◽  
Kidney Cysts ◽  
Acute Flank Pain

scholarly journals Non traumatic spinal epidural haematoma

2019 ◽  
Vol 18 (4) ◽  
pp. 255-258
Author(s):  
Naureen Abdul Khalid ◽  
◽  
Nainal Shah ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Trauma Surgery ◽  
Epidural Haematoma ◽  
Rare Condition ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Spinal Epidural Haematoma ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.

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