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Laparoscopic treatment of a spontaneously ruptured kidney (wunderlich syndrome).

Bretterbauer KM, Markić D, Colleselli D, Hruby S, Magdy A, Janetschek G, Mitterberger MJ - Case Rep Urol (2015)

Bottom Line: Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition.If angioembolization is not available open surgery is in most cases the preferred approach.We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Clinics Salzburg, 5020 Salzburg, Austria.

ABSTRACT
Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view of large retroperitoneal hematoma and initial incision of parietal peritoneum above the hematoma. 160 × 122 mm (116 × 117 DPI).
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fig3: Intraoperative view of large retroperitoneal hematoma and initial incision of parietal peritoneum above the hematoma. 160 × 122 mm (116 × 117 DPI).

Mentions: We choose the transperitoneal laparoscopic approach. The following briefly describes the operation. Under prophylactic antibiotic therapy and after induction of general anesthesia the patient was placed in the lateral position. Surgery was done transperitoneally in a standard technique for nephrectomy using four ports (three 11 mm and one 5 mm) and a camera with a 30-degree lens. Immediately after entrance in the peritoneum a large retroperitoneal hematoma was seen (Figure 3). The colon was displaced by the hematoma. The operation was similar to standard nephrectomy. Briefly, the right colon was mobilized medially. The second portion of the duodenum was dissected and the anterior surface of the vena cava was exposed. The renal vessels were isolated and clipped with Hem-o-lok (Teleflex Medical, USA) and an adequate hemostasis was achieved. During the entire procedure there was persistent bleeding from the hematoma's surface. The specimen was placed in a laparoscopic entrapment bag and removed. Finally, the drain was placed and the port sites were closed. The blood loss during operation was 750 mL (including the hematoma blood content). The duration of operation was 120 minutes. No intraoperative complications were encountered. The specimen was sent to the uropathologist. Final histopathology showed a central renal AML without malignancy and with highest diameter of 10 cm.


Laparoscopic treatment of a spontaneously ruptured kidney (wunderlich syndrome).

Bretterbauer KM, Markić D, Colleselli D, Hruby S, Magdy A, Janetschek G, Mitterberger MJ - Case Rep Urol (2015)

Intraoperative view of large retroperitoneal hematoma and initial incision of parietal peritoneum above the hematoma. 160 × 122 mm (116 × 117 DPI).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374331&req=5

fig3: Intraoperative view of large retroperitoneal hematoma and initial incision of parietal peritoneum above the hematoma. 160 × 122 mm (116 × 117 DPI).
Mentions: We choose the transperitoneal laparoscopic approach. The following briefly describes the operation. Under prophylactic antibiotic therapy and after induction of general anesthesia the patient was placed in the lateral position. Surgery was done transperitoneally in a standard technique for nephrectomy using four ports (three 11 mm and one 5 mm) and a camera with a 30-degree lens. Immediately after entrance in the peritoneum a large retroperitoneal hematoma was seen (Figure 3). The colon was displaced by the hematoma. The operation was similar to standard nephrectomy. Briefly, the right colon was mobilized medially. The second portion of the duodenum was dissected and the anterior surface of the vena cava was exposed. The renal vessels were isolated and clipped with Hem-o-lok (Teleflex Medical, USA) and an adequate hemostasis was achieved. During the entire procedure there was persistent bleeding from the hematoma's surface. The specimen was placed in a laparoscopic entrapment bag and removed. Finally, the drain was placed and the port sites were closed. The blood loss during operation was 750 mL (including the hematoma blood content). The duration of operation was 120 minutes. No intraoperative complications were encountered. The specimen was sent to the uropathologist. Final histopathology showed a central renal AML without malignancy and with highest diameter of 10 cm.

Bottom Line: Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition.If angioembolization is not available open surgery is in most cases the preferred approach.We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Clinics Salzburg, 5020 Salzburg, Austria.

ABSTRACT
Spontaneous, nontraumatic retroperitoneal hemorrhage or Wunderlich syndrome (WS) is a rare but potential life-threatening condition. In most patients a bleeding renal neoplasm is the cause of the retroperitoneal hematoma. The management of this condition includes a conservative approach in the hemodynamically stable patients and active treatment in the unstable patients. Active treatment includes angioembolization or surgery. If angioembolization is not available open surgery is in most cases the preferred approach. We present a patient with a spontaneously ruptured kidney due to a central renal angiomyolipoma, which was treated by laparoscopic nephrectomy.

No MeSH data available.


Related in: MedlinePlus