Wünderlich Syndrome Associated with Obstructive Uropathy due to Coralliform Renal Lithiasis: Case Report and Literature Review.

Abstract

Wünderlich syndrome or non-traumatic spontaneous renal hemorrhage is a rare entity, with less than 500 cases reported to date. It has multiple associated risk factors, the tumoral etiology is the principal one and the angiomyolipoma is the most frequently associated benign tumor. Other causes that are less frequent are systemic diseases such as polyarteritis nodosa, ruptured renal cysts, coralliform renal lithiasis, among others. It´s most common clinical presentation only occurs in 20% of cases and consists of Lenk's triad. Even in cases where the triad is present, the initial diagnosis is by computed tomography (CT) where the retroperitoneal hematoma is observed and sometimes evidencing the underlying etiology as in cases of renal lithiasis. Treatment depends on its severity and extension, ranging from conservative treatment in mild cases to urgent surgery in cases with hemodynamic instability. We present the case of a 58-year-old male patient with previous inpatient history of acute urinary retention and the finding of right coralliform renal lithiasis, without accepting surgical treatment and was readmitted a few weeks later presenting the characteristic clinical Lenk´s triad he undergoing to simple abdominopelvic computed tomography TC, as initial study and reporting a right perirenal hematoma secondary to obstructive uropathy due to renal lithiasis.