Spontaneous subcapsular or perirenal haemorrhage caused by renal tumours. A urological emergency.
OBJECTIVE
Spontaneous perirenal haemorrhage is a rare abdominal emergency most commonly caused by solid renal tumours. The aim of this study was to evaluate the efficacy of different diagnostic methods and treatment modalities.


METHODS
A total of 9 patients (5 women and 4 men) with spontaneous subcapsular or perirenal haemorrhage caused by renal tumours were treated at two Finnish central hospitals over a period of 20 years.


CONCLUSIONS
All the patients presented with flank pain, often severe and associated with a palpable mass and a reduced haemoglobin concentration. Ultrasonography was abnormal in all cases where it was used, but was able to show the tumour and haemorrhage correctly in only one case (13%). Computed tomography had a sensitivity of 71%. Seven patients underwent extrafascial nephrectomy (5 renal cell cancers, 1 malignant oncocytoma and 1 angiomyolipoma) and two with known tuberous sclerosis and bilateral renal angiomyolipomas were treated by superselective embolization. As these few cases were all individual and were collected over a long period of time, general statements about diagnosis and treatment must be approached critically. It may be concluded, however, that spontaneous perirenal haemorrhage is often a surgical emergency necessitating great efforts in terms of diagnosis and treatment. Computed tomography should be performed on all patients nowadays. If the bleeding is caused by a malignant tumour, extrafascial nephrectomy is the treatment of choice. For those with benign tumours selective embolization should be used.
Hellström
P A
PA
Division of Urology, Oulu University Hospital, Finland.
Mehik
A
A
Talja
M T
MT
Siniluoto
T M
TM
Perälä
J M
JM
Leinonen
S S
SS
D018262:Adenocarcinoma, Clear Cell / Q000150:complications*; D018249:Adenoma, Oxyphilic / Q000150:complications*; D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000150:complications*; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007680:Kidney Neoplasms / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography