Case report of a spontaneous perirenal hematoma (Wunderlich syndrome) from renal adenocarcinoma

More than 200 observations of spontaneous perirenal hematoma, or Wunderlich syndrome, are reported in the literature. This syndrome is caused by a renal tumour (generally angiomyolipoma or adenocarcinoma) in more than 50% of cases. In these patients retroperitoneal hematoma often hides the tumour, which at times may not even be obvious upon surgical exploration. A case of bulky spontaneous hematoma is presented localized in the left perirenal space, caudally extended to the paravesical region, and caused by a small bleeding tumour, 2 cm in size and situated on the upper pole of the left kidney. Treatment included drainage of the retroperitoneal hematoma and enucleation of the tumour. Histologic examination revealed 'dark cell renal adenocarcinoma, G3 according to Fuhrmann, aspects of papillary aggregation, thin and interrupted pseudo-capsula'. The perirenal fat removed with the mass was tumour-free. At 15 months follow-up the patient was tumour-free and in good general conditions. It is held that in selected cases of spontaneous perirenal hematoma, in the presence of a poor functioning contralateral kidney, conservative surgery should be performed.