Spontaneous rupture of renal angiomyolipoma in the third trimester

Abstract

Angiomyolipoma (AML) is an uncommon benign tumor with the following three histologic features: adipocytes, smooth-muscle cells, and blood vessels with thickened walls [1]. It is more prevalent inwomen than inmen, suggesting that female hormones play a role in its growth. Most renal AMLs are asymptomatic and are found incidentally during imaging examination. Occasionally, however, patients have severe symptoms. The risk of spontaneous rupture during pregnancy is higher than that seen in nonpregnant women, and this complication can be catastrophic [2]. In addition, AML poses a difficult diagnostic and therapeutic challenge during pregnancy. We herein report a rare case of spontaneous renal AML rupture during pregnancy. We would like to remind obstetricians that this neoplasm should be considered when patients present with sudden-onset abdominal and back pain with hypotension or shock. A 31-year-old primiparous woman presented to our hospital at 37 weeks' gestationwith sudden-onset right upper abdominal pain radiating to her back; there were no other symptoms. The entire lower abdomen was tender, but the pain was more severe on the right side. The fetal heart rate was 50e70 beats/min, prompting emergency cesarean delivery for fetal distress. The 1and 5-minute Apgar scores were 8 and 10, respectively. During surgery, a long, narrow hematoma was noted at the mesentery and in the retroperitoneum. The patient's general condition was good, and her preoperative hemoglobin (Hb) level was 11.0 g/dL, but we opted for a nonexhaustive exploration of the retroperitoneal space due to the risk of rupture associated with handling this hematoma. The cesarean was completed, and computed tomography (CT) was suggested to the patient, but she declined. Her postoperative clinical