Spontaneous perirenal hemorrhage in a pregnant woman due to the rupture of a simple renal cyst

Saeed Aali,Fatemeh Moradi

doi:10.34172/jsums.2021.32

Abstract

Renal cysts are diagnosed by ultrasonography, computerized tomography (CT), or urography. A 36-year-old pregnant woman (G2, Ab1, within the gestational age of 38 weeks) with upper abdominal pain starting from two hours ago, vomiting, and nausea was referred to the emergency department. Although abdominal examinations revealed costovertebral angle tenderness, there were no signs of peritoneal irritation, and all vital signs of the patient were in a normal range. Initial investigation results including blood count (Hb: 11.4), BUN/Cr, Na/K, and UA were normal. She underwent a cesarean section (c/s) due to reduced fetal heart rate (FHR). After C/S,the CT scan showed a large left retroperitoneal hematoma with an anterosuperior displacement of the kidney and active bleeding in the cystic lesion of the upper pole of the kidney. Pathological examinations also confirmed a simple cyst. Overall, simple renal cysts should be considered as a rare cause of spontaneous perinatal hemorrhage (SPH) in pregnancy. The diagnosis and treatment of SPH in pregnancy are also critical challenges.

Highlights

Simple cysts are the most common cystic lesions that are prevalent in the human kidneys
This study reported a 36-year-old pregnant woman with a spontaneous massive hemorrhage of the left renal cyst
In general, simple renal cysts should be considered as a rare cause of spontaneous perinatal hemorrhage (SPH) in pregnancy

Summary

Introduction

Simple cysts are the most common cystic lesions that are prevalent in the human kidneys. This study reported a 36-year-old pregnant woman with a spontaneous massive hemorrhage of the left renal cyst. Abdominal ultrasonography showed severe left hydronephrosis and free fluid in the abdomen. The patient gradually lost hemoglobin and FHR and simultaneously received fluid and blood. She was transferred to the operating room and underwent a cesarean section. A large non-pulsatile hematoma was observed in the left retroperitoneal space with a slight leaky of blood into the peritoneal space. The abdomen was closed, and a CT scan of the abdomen and pelvis was performed with intravenous contrast, representing a large left retroperitoneal hematoma with an anterosuperior displacement of the kidney and active bleeding from a cystic lesion of the upper pole of the kidney (Figures 1 and 2). The pathological examination confirmed a simple cyst (Figure 3)

Findings

Discussion

Conclusion