Spontaneous Circumrenal Hæmatoma: (Section of Urology).
By spontaneous circum-renal haematoma is meant a condition of extensive extravasation of blood into the kidney bed and surrounding tissues, unassociated with trauma.Since this is manifested by a fairly uniform clinical picture, by similar operative findings, and by peculiar difficulties in treatment, I propose to discuss it as a clinical entity irrespective of its wide ultimate causation. Very few cases are reported in the English literature. Nevertheless, from the world literature I have collected 170 case reports, and on them, together with three further cases, I base the present paper.Etiologically the cases fall into three groups:-(1) Those due to definite disease of the kidney or its blood-vessels, 58%.(2) Those due to extra-renal causes, 22%.(3) Those cases whose cause is obscure, 20%.In the first group neoplasms and inflammations of the kidney, aneurysms of the renal artery and arteriosclerosis are obvious causes. Many cases are due to obstruction of the renal veins.The classical triad of abdominal pain, signs of internal haemorrhage, and a tumour in the loin are often obscured by the resemblance of an acute abdominal catastrophe.In acute cases, expectant treatment is almost invariably fatal. Evacuation of the clot, tamponage and drainage has a mortality of about 40%, whilst nephrectomy in 55 cases showed a mortality of 22%.
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