Limits...
Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease.

Biyik Z, Solak Y, Gaipov A, Ozbek O, Esen H, Turk S - Indian J Nephrol (2015 Jul-Aug)

Bottom Line: Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition.The reason of SRH was rupture of the cysts of ACKD.The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Nephrology, Selcuk University, Meram School of Medicine, Selcuk, Turkey.

ABSTRACT
Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44-year-old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

No MeSH data available.


Related in: MedlinePlus

Cystic structures whose walls are layered with cuboidal epithelium (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4495483&req=5

Figure 2: Cystic structures whose walls are layered with cuboidal epithelium (H and E, ×40)

Mentions: A 44-year-old man with ESRD caused by hypertensive nephropathy had been treated with hemodialysis for 3 years before being converted to PD. The patient presented with abdominal pain, left-sided loin pain and bloody peritoneal effluent during the 7th year of PD treatment. His blood pressure was 140/80 mmHg and heart rate was 82 bpm and rhythmic. He had low grade fever of 38.3°C. There was tenderness over abdomen and left loin. There was neither rigidity nor rebound tenderness over these areas. He denied diarrhea, vomiting, syncopal episode, and bloody stool. His peritoneal effluent seemed hemorrhagic, presented with red blood cells of 2000/mm3 and 0.1% of hematocrit. White cell count and differential of the peritoneal outflow fluid revealed a total count of 1540/mm3 (83% neutrophils). Laboratory values were as follows; white blood cells: 16.4 × 103, hemoglobin: 8 g/dl, C-reactive protein: 69 mg/L, erythrocyte sedimentation rate: 46 mm/h, and procalcitonin: 14.2 mg/dl. Coagulation profile and liver tests were within normal levels. Blood and peritoneal fluid were sent for culture and the patient was placed on ceftriaxone and vancomycin treatment with a presumptive diagnosis of continuous ambulatory PD-related peritonitis. Blood and peritoneal fluid cultures were negative for any bacterial and fungal infection. The hemoglobin value of the patient 2 days prior to current admission was 12.4 g/dl. The patient denied any rectal bleed or bloody vomiting. PD was halted and the patient underwent heparin-free hemodialysis with saline flushes. Abdominal ultrasound showed bilateral shrinked kidneys with multiple small-sized cysts. There was an exophytic cyst measuring 9 cm × 8 cm, filled with blood at the lower pole of the left kidney. Medical records showed that he had no cysts at the start of the renal replacement therapy. Abdominal computed tomography revealed that there was a lesion, which extends from the upper pole of the left kidney to the lower pole through which a hematoma was filling renal parenchyma, subcapsular space and perirenal area [Figure 1]. The patient was transfused with packed red blood cell suspensions and underwent left radical nephrectomy with presumptive diagnoses of renal cell cancer secondary to ACKD or cystic hematoma. Macroscopically, there was a cystic lesion, which was not demarcated from surrounding tissues and filled completely with necrotic bleeding tissues. Histopathologically, no focus of neoplasia was found [Figure 2]. After nephrectomy, hemoperitoneum disappeared and the patient recovered completely. He is still undergoing hemodialysis thrice weekly.


Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease.

Biyik Z, Solak Y, Gaipov A, Ozbek O, Esen H, Turk S - Indian J Nephrol (2015 Jul-Aug)

Cystic structures whose walls are layered with cuboidal epithelium (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495483&req=5

Figure 2: Cystic structures whose walls are layered with cuboidal epithelium (H and E, ×40)
Mentions: A 44-year-old man with ESRD caused by hypertensive nephropathy had been treated with hemodialysis for 3 years before being converted to PD. The patient presented with abdominal pain, left-sided loin pain and bloody peritoneal effluent during the 7th year of PD treatment. His blood pressure was 140/80 mmHg and heart rate was 82 bpm and rhythmic. He had low grade fever of 38.3°C. There was tenderness over abdomen and left loin. There was neither rigidity nor rebound tenderness over these areas. He denied diarrhea, vomiting, syncopal episode, and bloody stool. His peritoneal effluent seemed hemorrhagic, presented with red blood cells of 2000/mm3 and 0.1% of hematocrit. White cell count and differential of the peritoneal outflow fluid revealed a total count of 1540/mm3 (83% neutrophils). Laboratory values were as follows; white blood cells: 16.4 × 103, hemoglobin: 8 g/dl, C-reactive protein: 69 mg/L, erythrocyte sedimentation rate: 46 mm/h, and procalcitonin: 14.2 mg/dl. Coagulation profile and liver tests were within normal levels. Blood and peritoneal fluid were sent for culture and the patient was placed on ceftriaxone and vancomycin treatment with a presumptive diagnosis of continuous ambulatory PD-related peritonitis. Blood and peritoneal fluid cultures were negative for any bacterial and fungal infection. The hemoglobin value of the patient 2 days prior to current admission was 12.4 g/dl. The patient denied any rectal bleed or bloody vomiting. PD was halted and the patient underwent heparin-free hemodialysis with saline flushes. Abdominal ultrasound showed bilateral shrinked kidneys with multiple small-sized cysts. There was an exophytic cyst measuring 9 cm × 8 cm, filled with blood at the lower pole of the left kidney. Medical records showed that he had no cysts at the start of the renal replacement therapy. Abdominal computed tomography revealed that there was a lesion, which extends from the upper pole of the left kidney to the lower pole through which a hematoma was filling renal parenchyma, subcapsular space and perirenal area [Figure 1]. The patient was transfused with packed red blood cell suspensions and underwent left radical nephrectomy with presumptive diagnoses of renal cell cancer secondary to ACKD or cystic hematoma. Macroscopically, there was a cystic lesion, which was not demarcated from surrounding tissues and filled completely with necrotic bleeding tissues. Histopathologically, no focus of neoplasia was found [Figure 2]. After nephrectomy, hemoperitoneum disappeared and the patient recovered completely. He is still undergoing hemodialysis thrice weekly.

Bottom Line: Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition.The reason of SRH was rupture of the cysts of ACKD.The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Nephrology, Selcuk University, Meram School of Medicine, Selcuk, Turkey.

ABSTRACT
Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44-year-old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

No MeSH data available.


Related in: MedlinePlus