Wunderlich Syndrome Research Articles

Bilateral Wunderlich syndrome causing Page kidney during pregnancy: a rare case report.

The patient presented with complaints of left flank pain and breathlessness. After stabilization, an emergency lower cesarean delivery was performed, and a percutaneous drainage procedure was carried out to alleviate the compression on the left kidney. The patient was treated with blood transfusion, methyldopa, and perindopril. Follow-up examinations performed 3 months later revealed a significant decrease in fluid volume surrounding the left kidney. Lenk's triad provides the primary description of the classical manifestations of this syndrome. Some instances have been connected to the Page kidney phenomenon. The relationship between pregnancy and Wunderlich syndrome has not been extensively studied, primarily because the symptoms can resemble other complications related to pregnancy. Due to the scarcity of evidence in the literature, there is no definitive guideline for managing Wunderlich syndrome during pregnancy. Consequently, each patient is treated on an individual basis. Conservative treatment is recommended once malignancy has been ruled out. The case highlights the importance of considering Wunderlich syndrome as a differential diagnosis in pregnant patients with abdominal or flank pain, a palpable mass, and hypovolemia. Furthermore, the case illustrates the successful management of Wunderlich syndrome during pregnancy.

Spontaneous rupture of a benign renal cyst A rare and misleading cause of Wunderlich syndrome

Wunderlich syndrome (WS) is a rare condition characterized by acute onset of spontaneous renal hemorrhage into the subcapsular and perirenal spaces. Wunderlich syndrome is classically characterized by the Lenk's triad: acute flank pain, flank mass, and hypovolemic shock. In this vignette; we describe our experience with a previously healthy adult female who presented with loin pain for weeks followed by gross hematuria, anemia and hypotension. Ultrasound examination of the abdomen and pelvis revealed; (a) an ill-defined hyperechoic mass-like lesion measuring 4.6X4.1 cm at its upper pole of right kidney which, on doppler study, had minimal internal vascularity, (b) moderate perinephric hematoma, moderate hydroureter and hydronephrosis. Triphasic CT scan and MRI, with contrast, of the abdomen and pelvis disclosed a case of ruptured benign cyst and ruled out renal cancer and vascular etiologies. The patient was treated conservatively and did not require renal embolization or nephrectomy. In conclusion; ruptured renal cysts is a rare cause for WS yet requires prompt management with patient’s stabilization and diagnostic approach. Contrary to the more common etiologies viz. tumors and vasculopathy; it rarely requires more than conservative treatment in stable patients.

Laparoscopic resolution of Wünderlich syndrome as a primary treatment

Background: Spontaneous Retroperitoneal Hemorrhage, named Wünderlich Syndrome (WS) is usually managed by emergency surgeons with a conventional laparotomy. The aim is to report a patient with WS successfully treated by a laparoscopic approach avoiding open surgery. Methods: A 50-year-old female was diagnosed with WS hemodynamic instability and flank pain. After a normal CT scan that discarded visceral injuries and stabilized, the patient underwent a laparoscopic renal exploration. Results: Laparoscopic approach was as standard transperitoneal renal access. Fortunately, the hematoma was within Gerota fascia meaning a non-complex surgery. Due to the high R.E.N.A.L. score, it was necessary to complete a radical nephrectomy. Surgical time was 120 minutes without perioperative complications and the renal unit was retrieved using a Pfannenstiel incision. Estimate blood loss was not quantified. Finally, the hospital stay was 24 hrs. Conclusion: Laparoscopic approach could be performed in selected patients with WS especially when are hemodynamic stabilized with no visceral injury associated. Immediately treatment could facilitate the procedure because it avoids adherences or fibrosis due to hematoma. Experience in the laparoscopic approach is necessary.

Erratum for: Wunderlich Syndrome: Comprehensive Review of Diagnosis and Management

Erratum for: Wunderlich Syndrome: Comprehensive Review of Diagnosis and Management

Wunderlich Syndrome in a Peritoneal Dialysis Patient with Warfarin Iatrogenic Coagulopathy: Should We Really be so Aggressive on Cardioembolic Events Prevention?

Wunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high index of suspicion, since its classical presentation with Lenk’s triad is only seen in less than a quarter of patients. Early detection is of outmost importance because of this syndrome potential for causing hemodynamic instability and shock. Spontaneous renal hemorrhage has been reported much less frequently in peritoneal dialysis as compared to hemodialysis. To our knowledge, only 3 single-cases involving peritoneal dialysis patients were published since the year 2000. We describe an uncommon case report of a 68-year-old male undergoing continuous ambulatory peritoneal dialysis for 5 years and taking warfarin for permanent atrial fibrillation who developed Wunderlich syndrome presenting with Lenk’s triad. The patient was managed with percutaneous drainage of the renal hemorrhage and was able to continue peritoneal dialysis in the acute phase of disease. Unfortunately, he subsequently developed peritoneal membrane failure having to transition to hemodialysis 2.5 months after the WS episode. The authors will review literature on Wunderlich syndrome on end-stage kidney disease patients, discuss oral anticoagulation on peritoneal dialysis patients, maintenance of the technique, and finally, address the consequences of Wunderlich syndrome on peritoneal membrane diffusion capacity.

Management Outcomes of Large Renal Angiomyolipoma Presenting with Wunderlich Syndrome-Experience from a Tertiary Center.

Renal angiomyolipoma is an uncommon, benign-mixed mesenchymal tumor consisting of thick-walled blood vessels, smooth muscles, and mature adipose tissues. Twenty percent of these tumors are associated with tuberous sclerosis. Wunderlich syndrome (WS), an acute nontraumatic spontaneous perirenal hemorrhage, can be a presentation of large angiomyolipoma. This study evaluated the presentation, management, and complications of renal angiomyolipoma with WS in eight patients who presented to the emergency department between January 2019 and December 2021. The presenting symptoms included flank pain, palpable mass, hematuria, and bleeding in the perinephric space on computerized tomography. Demographic data, symptoms at presentation, comorbidities, hemodynamic parameters, the association with tuberous sclerosis, transfusion requirements, need for angioembolization, surgical management, Clavien-Dindo complication, duration of hospital stay, and 30-day readmission rates were evaluated. The mean age of presentation was 38 years. Of the eight patients, five (62.5%) were females and 3(37.5%) were males. Two (25%) patients had tuberous sclerosis with angiomyolipoma, and three (37.5%) patients presented with hypotension. The mean packed cell transfusion was three units, and the mean tumor size was 7.85 cm (3.5-25 cm). Three of them (37.5%) required emergency angioembolization to prevent exsanguination. Embolization was unsuccessful in one patient (33%) who underwent emergency open partial nephrectomy, and one (33%) patient developed post-embolization syndrome. A total of six patients underwent elective surgery-four underwent partial nephrectomy (laparoscopic - 1, robotic - 1, open - 2) and two underwent open nephrectomy. Three patients encountered Clavien-Dindo complications (Grade 1, n = 2 and IIIA, n = 2). WS is a rare, life-threatening complication in patients with large angiomyolipoma. Judicious optimization, angioembolization, and prompt surgical intervention will help deliver better outcomes.

Spontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus: a case report

BackgroundSpontaneous perirenal hemorrhage (Wunderlich syndrome) in the fetus is a rare urinary system disease. Prenatal ultrasound diagnosis presents challenges due to the lack of specific clinical features.Case presentationA 27-year-old Chinese woman gravida 2 para 0 found her fetus with the left Wunderlich syndrome accompanying bilateral hydronephroses and bladder dysfunction with an early diagnosis through prenatal ultrasound and postnatal magnetic resonance imaging. After a timely emergency cesarean section, the infant was administrated antimicrobial prophylaxis and an indwelling catheter treatment. Ultrasound follow-up showed his urinary system gradually developed normally.ConclusionA fetus with bilateral hydronephroses accompanying bladder dysfunction should be observed because of the risk of spontaneous renal rupture with hemorrhage formation. Ultrasound and magnetic resonance imaging play a vital role in the diagnosis and follow-up of Wunderlich syndrome. Early diagnosis facilitates better pregnancy planning and appropriate care of newborns.

ANGIOMYOLIPOMA – VARIED PRESENTATIONS – A CASE SERIES

Renal angiomyolipoma is a benign mesenchymal tumour composed of fat cells, smooth muscle cells, and thick-walled blood vessels. These tumors can occur sporadically or as part of genetic syndromes: most commonly tuberous sclerosis complex. Here we present three cases of Renal angiomyolipoma(AML) in different scenarios - presenting with clinical features like ank pain, abdominal mass or perirenal haematoma with hypovolemic shock. All three cases were evaluated by contrast enhanced CT & diagnosed as renal angiomyolipoma. Nephron sparing surgery - Partial nephrectomy was done in case 1. Case 2 underwent angiography with non- selective angioembolisation preoperatively followed by simple nephrectomy. Case 3, after initial stabilization and evaluation found to be a case of Wunderlich syndrome and simple nephrectomy done. Post intervention period was uneventful for all 3 cases. In the 6-month follow-up, all three patients were doing well with normal renal function and no recurrence in case of partial nephrectomy. Embolisation is the emergency treatment of choice for bleeding angiomyolipoma. Whenever possible, a nephron sparing approach by either transarterial embolisation or partial nephrectomy is to be considered. In cases of angiomyolipoma of both kidneys or in a solitary functioning kidney, renal preservation is mandatory in order to avoid need for renal replacement therapy. Also, recently approved drug Everolimus may be considered for patients not suitable for surgery particularly in tumour seen with tuberous sclerosis

WUNDERLICH'S SYNDROME IN A PATIENT WITH ADVANCED TUBEROUS SCLEROSIS COMPLEX WITH LARGE ANGIOMYOLIPOMA

Wunderlich's syndrome, or spontaneous non-traumatic retroperitoneal hemorrhage, can be a life-threatening event. Renal angiomyolipoma is a rare benign tumor that can occur sporadically, or in association with tuberous sclerosis. A case of spontaneous retroperitoneal hemorrhage in a patient with tuberous sclerosis and renal angiomyolipoma is presented. Tuberous sclerosis complex is a rare symptom complex and may have varied presentations.We present a case of hypovolemic shock due to spontaneous rupture of large angiomyolipoma in a 24-year-old male patient with tuberous sclerosis complex (TSC).The hemodynamic instability of our patient leads to an urgent surgery and right nephrectomy was done for the angiomyolipomas. Spontaneous hemorrhage in renal angiomyolipoma in a case of tuberous sclerosis and management are discussed.

Intraoperative cell salvage in the treatment of Wunderlich syndrome caused by renal angiomyolipoma

Introduction. Wunderlich syndrome is defined as acute spontaneous hemorrhage into the subcapsular and perirenal spaces in the absence of trauma. The most common causes of Wunderlich syndrome are various renal neoplasms, polycystic and vascular kidney diseases. Wunderlich syndrome is common in patients who use anticoagulant therapy or suffer from various types of congenital coagulopathies. The clinical diagnosis is usually confirmed by computer tomography of the abdomen and requires urgent surgical treatment or renal artery embolization. Case Report. A 45-year-old woman was admitted to the Emergency Center due to acute pain in the left abdomen, associated with arterial hypotension. A computer tomography of the abdomen was performed using intravenous contrast, which showed a ruptured tumor of the left kidney with a massive retroperitoneal hematoma. The tumor was 7 cm in diameter and according to the computer tomography data it corresponded to an angiomyolipoma. The patient underwent emergency surgery. Intraoperative cell salvage was used with additional blood replacement. Nephrectomy and drainage of the massive retroperitoneal hematoma were performed. Pathohistological analysis of the surgically removed kidney confirmed a renal angiomyolipoma. Conclusion. Wunderlich syndrome caused by the rupture of angiomyolipoma is still a life-threatening condition that should be considered in the differential diagnosis of sudden abdominal pain, especially in women of reproductive age. In hypotensive patients, available radiological methods should be used to make an accurate diagnosis, before taking the patient to the operating room.

Double the trouble: A case report on uterine didelphys with unilateral cervical atresia

Genetic errors and teratogenic events during embryonic development can lead to congenital abnormalities of the female reproductive tract. Many patients are asymptomatic, while some have major abnormalities that can cause severe impairment of menstrual and reproductive functions. This case report focuses on Müllerian anomaly Class III, uterine didelphys, along with obstructed hemivagina and ipsilateral renal agenesis (the Herlyn–Werner–Wunderlich syndrome [HWWs]). The patient presented with cyclic pelvic pain due to the hematometra and hematocolpos. She initially underwent resection of the vaginal septum but had a recurrence of obstructive symptoms more than a year after vaginal surgery was performed. This prompted further evaluation with magnetic resonance imaging revealing cystic dilatation of the right uterine horn and a hypoplastic right vagina appearing to end blindly. The patient subsequently underwent hemihysterectomy. The right hemiuterus was noted to have a depression on its thickened inferior aspect, but no cervix was identified. This case is a variant of the classic HWWS, as there was cervical atresia on the right uterine corpus. A thorough preoperative evaluation and accurate intraoperative assessment of patients with Müllerian anomalies can decrease misdiagnoses, guide appropriate intervention, and decrease the risk of future reproductive complications.

Papillary Renal Cell Carcinoma with Massive Hemorrhage: An Autopsy Case Report

Abstract Introduction/Objective Spontaneous renal hemorrhage is a rare complication of various kidney pathologies. It can be due to renal artery aneurysms, arteriovenous malformations, cystic renal diseases, renal calculus, coagulation disorders, as well as neoplastic lesions like angiomyolipoma and renal cell carcinoma (RCC). Individuals present with sudden flank or scapular pain, hypovolemic shock, termed as Wunderlich syndrome (WS). 30-35% cases of WS are from spontaneously ruptured RCC, commonly clear cell variant (70%) followed by papillary (10-15%) and chromophobe variant (4-6%). We present an autopsy case of a papillary variant RCC identified as a small kidney mass with a pathogenetic correlation behind the intractable bleeding. Methods/Case Report An 81-year-old Caucasian man with a history of atrial fibrillation, on long-term Xarelto treatment, was found to have a 1.2 cm incidental mass in the right kidney. He started experiencing right-sided scapular pain, then rapidly became hypotensive, drowsy. CT scan revealed a large right-sided perinephric and retroperitoneal hematoma (17.5 x 5.7 x 8.9 cm) extending in the pelvis. Despite receiving blood products, other supportive treatment, and successful angio-embolization, his condition worsened to acute kidney injury, bowel ischemia, and persistent lactic acidosis leading to death. On autopsy, bloody ascites, clots on mesenteric root insertion, and bulging in retroperitoneal spaces were seen. The perinephric spaces had organized clots. The bleeding originated from a 2.0 x 2.0 cm brown mass in the middle pole of the right kidney. There was a slit-like vessel at the interface of the kidney and the mass. Microscopic examination of the mass shows trabecula of abnormal cells with abundant eosinophilic cytoplasm in the hemorrhagic and necrotic background. These cells are positive for PAX8, CK7, CD10, dim positive for CAIX, and negative for CD117, which is consistent with renal cell carcinoma, papillary variant. Results (if a Case Study enter NA) NA. Conclusion Papillary RCC is much less vascular and less aggressive than clear cell RCC. However, necrosis or bleeding into renal vessels may occur. In this case, blood-leaks and accumulation in enclosed space followed by necrosis, fibrosis, and hyalinization cause neovascularization forming a negative spiral for re-bleeding. Anticoagulants can lead to profuse sustained bleeding from even very small size RCC.

Life-Threatening Wunderlich Syndrome Associated with Apixaban and the Complexity of Anticoagulation Management in Bleeding Patients: A Case Report.

Wunderlich syndrome is a rare and possibly life-threatening haemorrhagic syndrome presenting as spontaneous nontraumatic renal rupture with subcapsular and perinephric haemorrhage. Apixaban, a direct oral anticoagulant recommended in patients with atrial fibrillation, has previously been associated with atraumatic solid organ rupture but, to date, no case of apixaban-related Wunderlich syndrome has been reported. We report a rare case of Wunderlich syndrome associated with apixaban while addressing the difficulties face by clinicians when managing anticoagulation in bleeding patients.

Computed Tomography Findings in Wunderlich Syndrome

Computed Tomography Findings in Wunderlich Syndrome

Conservative Treatment of Didelphyc Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis

To show a conservative surgical treatment for a female adolescent affected by Wunderlich syndrome with didelphys uterus and obstructed hemivagina. Stepwise demonstration of the technique with narrated video footage. In the context of obstructive congenital müllerian anomalies, involving a stagnation of menstrual blood, the Wunderlich syndrome is the most common and constantly characterized by the duplicity of the uterine body, by the presence of an imperforate hemivagina, and by renal agenesis ipsilateral to the obstructed hemivagina. The imperforate hemivagina leads to dysmenorrhea and abdominal pain, owing to the hematocolpos and the hematometra, which arose immediately after the menarche. This is the case of a 14-year-old female adolescent affected by Wunderlich syndrome referred to the San Raffaele Hospital adolescent center (Milan, Italy) for dysmenorrhea and abdominal pain. At vaginal exploration, a right imperforated hemivagina and hematocolpos were highlighted. A diagnostic magnetic resonance imaging (MRI) found the duplicity of the uterine body, the hematometra, and the right renal agenesis. A combination of explorative laparoscopy and surgical vaginal time leads to the excision of the vaginal septum that allows the drainage of the hematocolpos and of the hematometra. Three surgical steps are described: 1. First laparoscopic step: exploration of the abdominal cavity with the detection of a double uterine body, an enlarged hemiuterus, and an enlarged hemivagina caused by the hematometra and the hematocolpos. Careful evaluation of adnexa for eventual presence of hematosalpinx. 2. Vaginal step divided into the following: (A) puncture of the vaginal tumescence (corresponding to the imperforated hemivagina) with a 19-gauge needle mounted on a syringe. Aspiration results in thick creamy black material (old menstrual blood). (B) In correspondence with the needle puncture, a full-thickness incision of the vaginal wall widely opening the second uterine cervix and (C) stabilization of the opening by the marsupialization of the edge of the obstructed hemivagina were performed. 3. Second laparoscopic step: having emptied the hematocolpos of the left hemiuterus, the didelphys uterus and the disappearance of the hematocolpos can be clearly seen. Here, we demonstrate a conservative surgical approach for the treatment of Wunderlich syndrome. This rare malformation is characterized by an extreme variability of the anatomic presentation, and the precise identification of the variety together with the early diagnosis is of fundamental importance for the surgical correction.

A Case of Spontaneous Renal Haemorrhage (Wunderlich Syndrome) in an Anticoagulated Patient.

Spontaneous renal haemorrhage is a rare but severe condition known as Wunderlich syndrome (WS). The classic presentation includes sudden-onset flank pain, a palpable flank mass and hypovolaemic shock (Lenk’s triad). WS can be due to neoplasms, vascular diseases, cystic rupture, coagulopathies and infections. A contrast-enhanced CT scan of the abdomen is mandatory for diagnosis. Surgery is reserved for haemodynamically unstable patients and those with neoplastic disease. We describe a case of WS in an anticoagulated patient with chronic atrial fibrillation, diabetes mellitus type 2 and hypertension, who developed acute renal failure and severe anaemia, that completely resolved with conservative treatment and discontinuation of anticoagulation therapy.LEARNING POINTSWunderlich syndrome refers to spontaneous renal or perinephric haemorrhage.Contrast-enhanced CT of the abdomen is the gold standard for diagnosis.Surgery should be reserved for haemodynamically unstable patients or those with neoplastic disease.

Wunderlich syndrome, an unexpected urological complication in a patient with coronavirus disease 2019 (COVID-19): A case report.

We describe the first case of Wunderlich syndrome as a hemorrhagic complication in a patient with severe acute respiratory syndrome coronavirus 2 infection and acute respiratory distress syndrome. The possible underlying pathophysiological mechanisms have been extensively discussed. Emergency management included selective angioembolization of the upper polar arterial branches of the left kidney and discontinuation of thromboprophylaxis. The patient was discharged after 18 days. No other localizations or local recurrence of bleeding occurred during the hospitalization. Our report suggests a broad spectrum of clinical manifestations in patients with coronavirus disease 2019. As observed in our clinical case, in addition to thrombotic complications, bleeding is a significant cause of morbidity in coronavirus disease 2019 patients. Further studies should determine whether these urological bleeding sequelae are a direct manifestation of the infection or an indirect effect of thromboprophylaxis.

Pregnancy complicated with Wunderlich's syndrome: Anaesthetic challenges.

Pregnancy complicated with Wunderlich's syndrome: Anaesthetic challenges.

СОПОСТАВЛЕНИЕ РЕЗУЛЬТАТОВ УЗИ, КТ И МРТ ПРИ ДИАГНОСТИКЕ АНГИОМИОЛИПОМЫ ПОЧКИ, В ТОМ ЧИСЛЕ ОСЛОЖНИВШЕЙСЯ РАЗВИТИЕМ СИНДРОМА ВУНДЕРЛИХА

Purpose: Analysis the effectiveness of various methods of radiation studies for the detection of renal angiomyolipomas (RAMLs), including the diagnosis of Wunderlich syndrome.
 Material and methods: The analysis of the results of a comprehensive radiation study of the kidneys of 115 patients who were diagnosed with focal formation in primary renal ultrasound was carried out. Further, of those 115 people, 47 patients underwent MRI of the kidneys, 60 patients – CT and 8 patients complex MRI+CT, including contrast-enhanced vasculature.
 Results and discussion: Angiomyolipoma was detected by ultrasound in 38 (33.0 %) of 115 patients, and according to MRI and CT in total in 27 (23.5 %) patients. Coincidence of ultrasound findings and MRI and CT results was in 18 patients. Consequently, the sensitivity of ultrasound in the diagnosis of RAML was compared with MRI – 45 %; when compared with CT – 42.8 %, and specificity – 55 % and 57.1 %, respectively. Reliable signs of RAML in ultrasound were hyperechogenic homogeneous structure, clear smooth contours of the formation. The rounded form of education is statistically unreliable. Statistically significant characteristics of RAML in magnetic resonance imaging are heterogeneous structure, heterogeneous hyperintense MR-signal on T1 and heterogeneously hypointensity on T2-weighted images, always uniformly hypo-Fs for T1 / T2 Fs, with hypo clear boundary between education and renal parenchyma on T1 in the opp phase. Reliable signs of RAML with CT are non-uniform structure of education, with non-uniform x-ray density. 
 Conclusion: Ultrasound diagnosis is necessary for screening kidney disease, while CT and MRI have greater sensitivity and specificity to determine the nature of focal formation. With the development of Wunderlich’s syndrome, a complex of radiological methods, including ultrasound, MRI and CT, allows to diagnose the cause of hemorrhage, as well as to obtain complete diagnostic information necessary for the surgeon to plan treatment.

Síndrome de Wünderlich (hemorragia renal espontánea) Reporte de un caso

Background and objectives: Non-traumatic, spontaneous renal hemorrhage was first described in 1700 by Bonet, it was until 1856 that the physician Carl August Wünderlich made a complete clinical description and called it spontaneous apoplexy of the renal capsule. In 1910 Coenen reported a series of 13 cases and gave it the name Wünderlich syndrome. To date, about 300 cases have been reported in the medical literature. The objective of reporting a new case of Wünderlichsyndrome is to share a relatively rare and underdiagnosed clinical entity with physicians. Material and Method: The clinical case of an 88-year-old woman who was admitted to the emergency department with abdominal pain and hypovolemic shock is presented. A complete medical history was performed, and laboratory tests were taken, studies including chest radiography and simple and contrasted abdominal computed tomography were performed. She undergoes emergency surgery with the findings of a significant renal hemorrhage, nephrectomy is performed. Clinical and radiological data and histopathological findings are analyzed. Results: Based on the surgical findings and the results of the histopathological study and finding no clinical history of trauma, but if the presence of a renal cyst where the spontaneous bleeding was caused the conclution is that it’s a Wunderlich syndrome. Conclusions: Wunderlich syndrome or Spontaneous Renal Hemorrhage is a relatively rare clinical entity, characterized by sudden onset abdominal pain and clinical data of hypovolemia that every physician must know in order to establish a timely diagnosis and treatment. Key words: Hypovolemia; retroperitoneal hemorrhage; computed axial tomography; medical history; Lenk triad. Background and objectives: Non-traumatic, spontaneous renal hemorrhage was first described in 1700 by Bonet, it was until 1856 that the physician Carl August Wünderlich made a complete clinical description and called it spontaneous apoplexy of the renal capsule. In 1910 Coenen reported a series of 13 cases and gave it the name Wünderlich syndrome. To date, about 300 cases have been reported in the medical literature. The objective of reporting a new case of Wünderlichsyndrome is to share a relatively rare and underdiagnosed clinical entity with physicians. Material and Method: The clinical case of an 88-year-old woman who was admitted to the emergency department with abdominal pain and hypovolemic shock is presented. A complete medical history was performed, and laboratory tests were taken, studies including chest radiography and simple and contrasted abdominal computed tomography were performed. She undergoes emergency surgery with the findings of a significant renal hemorrhage, nephrectomy is performed. Clinical and radiological data and histopathological findings are analyzed. Results: Based on the surgical findings and the results of the histopathological study and finding no clinical history of trauma, but if the presence of a renal cyst where the spontaneous bleeding was caused the conclution is that it’s a Wunderlich syndrome. Conclusions: Wunderlich syndrome or Spontaneous Renal Hemorrhage is a relatively rare clinical entity, characterized by sudden onset abdominal pain and clinical data of hypovolemia that every physician must know in order to establish a timely diagnosis and treatment. Key words: Hypovolemia; retroperitoneal hemorrhage; computed axial tomography; medical history; Lenk triad.