Spontaneous retroperitoneal hemorrhage due to rupture of a renal angiolipoma in a 37-week pregnancy: a case of Wünderlich syndrome

Abstract

Introduction

Wünderlich syndrome is defined as spontaneous, non-traumatic retroperitoneal bleeding, often associated with the rupture of a renal angiomyolipoma. Though rare, this condition is life-threatening if not treated promptly. The syndrome is particularly uncommon during pregnancy, posing significant challenges in diagnosis and management due to overlapping symptoms with other obstetric emergencies.

Case Presentation

We report the case of a 25-year-old woman at 37 weeks of gestation who presented to the emergency department with hypovolemic shock, left flank pain, and fetal bradycardia. A large retroperitoneal hematoma was discovered during an emergency caesarean section, later identified as secondary to a ruptured renal angiomyolipoma. Despite the critical presentation, a total nephrectomy was performed successfully, and both mother and child had favorable outcomes.

Conclusion

This case highlights the importance of considering Wünderlich syndrome in differential diagnoses of acute abdominal pain during pregnancy, especially in the presence of shock and renal masses. Prompt interdisciplinary management is crucial for positive maternal and fetal outcomes.