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

Abstract

Wunderlich syndrome is a rare and life-threatening condition that is characterized by spontaneous renal hemorrhage into the subcapsular and perinephric regions. This case report describes the diagnosis and management of bilateral Wunderlich syndrome during pregnancy, resulting in Page kidney.

Case presentation: 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.

Clinical discussion: 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.

Conclusion: 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.

Keywords: Lenk’s triad; bilateral Wunderlich syndrome; pregnancy complications; spontaneous retroperitoneal hemorrhage.

Figure 1

Depicts a contrast-enhanced computed tomographic scan revealing extensive perirenal hematomas enveloping both kidneys. On the right, the maximum thickness measures 41 mm with an upper/lower diameter of 211 mm, while on the left, the maximum thickness measures 106 mm with an upper/lower diameter of 305 mm. These hematomas cause compression of the adjacent kidney tissue.

Figure 2

Computed tomography urogram reveals a mild decrease in the function of the left kidney.