Large Retroperitoneal Haemorrhage Following Cyst Rupture in a Patient with Autosomal Dominant Polycystic Kidney Disease

Abstract

The complications of autosomal dominant polycystic kidney disease (ADPKD) include cyst rupture and haemorrhage leading to loin pain and frank haematuria. Risk factors include large kidney volume, hypertension, and renal impairment. We present a case of a young male who, following trauma to the kidney, had a life threatening bleed from his polycystic kidney. The case was initially treated with fluid resuscitation and blood transfusion but necessitated radiological embolization of bleeding source to control the blood loss. We review the risk factors and management of cyst haemorrhage in patients with ADPKD. Contact sports should be avoided as cyst rupture can lead to severe life threatening haemorrhage.

Figure 1

Computerised tomography (CT) of abdomen and left renal arteriogram and embolization of a patient with autosomal dominant polycystic kidney disease demonstrating large left renal retroperitoneal haemorrhage. Sagittal views (a and b) and (c) axial view of contrast enhanced CT abdomen showing bilateral polycystic kidneys with evidence of large volume haemorrhage which surrounds the left kidney and extends into the retroperitoneal space. Super-selective angiogram of the left renal artery lower polar segmental branch showing an extravasation into the lower polar renal cyst (d) and final, postembolization angiogram confirming satisfactory exclusion of the source of bleed (e and f).