Ulus Travma Acil Cerrahi Derg. 2023; 29(5): 641-643 | DOI: 10.14744/tjtes.2022.54502

Wunderlich syndrome secondary to ureteropelvic junction obstruction

Necmi Bayraktar
Department of Urology, Burhan Nalbantoglu State Hospital, Nicosia-North Cyprus; Department of Urology, Near East University School of Medicine, Nicosia-North Cyprus

Wunderlich syndrome (WS) is defined as a rare spontaneous renal hemorrhage. It mostly occurs with concomitant diseases without trauma. It usually presents with the Lenk triad and is diagnosed in emergency departments with the effective use of advanced imaging modalities such as ultrasonography, computerized tomography, or magnetic resonance imaging scanning. In the management of WS, conservative treatment, interventional radiology, or surgical procedures are decided according to the patient’s condition and treated appropriately. Conservative follow-up and treatment should be considered in patients whose diagnosis is stable. If diagnosed late, the progression can be life-threatening. As an interesting case of WS, a 19-year-old patient was presented with hydronephrosis due to ure-teropelvic junction obstruction. Spontaneous renal hemorrhage without a history of trauma is presented. The patient, who presented to the emergency department with the sudden onset of flank pain, vomiting, and macroscopic hematuria was imaged by computed tomography. The patient could be followed and treated conservatively for the first 3 days, and on the 4th day, his general condition deteriorated, and he underwent selective angioembolization and then laparoscopic nephrectomy. WS is a serious, life-threatening emer-gency, even in young patients with benign conditions. Early diagnosis is mandatory. Delays in diagnosis and non-energetic approaches can lead to life-threatening situations. In hemodynamically unstable non-malignant cases, the decision for immediate treatment, such as angioembolization and surgery, should be taken without hesitation.

Keywords: Laparoscopic simple nephrectomy, selective angioembolization, spontaneous renal hemorrhage; wunderlich syndrome.

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Üreteropelvik bileþke darlýðýna sekonder Wunderlich sendromu

Necmi Bayraktar
Burhan Nalbantoðlu Devlet Hastanesi, Üroloji Departmaný, Nicosia; Yakýn Doðu Üniversitesi Týp Fakültesi, Üroloji Departmaný, Nicosia

Wunderlich sendromu, nadir görülen bir spontan böbrek kanamasý olarak tanýmlanýr. Çoðunlukla travma olmaksýzýn zemininde eþlik eden has-talýklarla ortaya çýkar. Genellikle Lenk triadý ile prezente olur ve acil servislerde ultrasonografi, BT veya MRG taramasý gibi geliþmiþ görüntüleme yöntemlerinin etkin kullanýmý ile teþhis edilir. Wunderlich sendromunun tedavisinde konservatif tedavi, giriþimsel radyoloji veya cerrahi prosedürler kullanýlarak, hastanýn durumuna göre karar verilir ve uygun yöntemle tedavi edilir. Taný da stabil olan hastalarda konservatif takip ve tedavi düþünül-melidir. Geç teþhis edilirse, progrese olmasý halinde hayat tehdit edici olabilir. Ýlginç bir Wunderlich Sendromu olgusu olarak, 19 yaþýnda üretero-pelvik bileþke (UPJ) obstrüksiyonuna baðlý hidronefroz hastasýnda, travma öyküsü olmayan spontan böbrek kanamasý sunulmaktadýr. Ani baþlayan yan aðrýsý, kusma ve makroskopik hematüri þikayetleri ile acil servise baþvuran hastanýn bilgisayarlý tomografisi çekildi. Ýlk üç gün konservatif olarak takip ve tedavi edilen hasta, 4. günde genel durumu bozulmasý üzerine hastaya selektif anjiyoembolizasyon ve ardýndan laparoskopik nefrektomi uygulandý. Wunderlich sendromu, benign hastalýklar zemininde genç hastalarda dahi ciddi, yaþamý tehdit eden bir acil durumdur. Erken teþhis önem arzeder. Tanýdaki gecikmeler ve enerjik olmayan yaklaþýmlar yaþamý tehdit eden durumlara yol açabilir. Hemodinamik olarak stabil olmayan benign vakalarda da, anjiyoembolizasyon ve cerrahi gibi acil tedavi kararý tereddüt etmeden alýnmalýdýr.

Anahtar Kelimeler: Laparoskopik basit nefrektomi, selektif anjioembolizasyon, spontan böbrek kanamasý; Wunderlich sendromu.

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