title: Spontaneous rupture of a giant renal angiomyolipoma-Wunderlich's syndrome: Report of a case.
abstract: BACKGROUND
  Herein we present a rare case of pontaneous rupture of a giant renal angiomyolipoma (AML), with symptoms of hypovolemic shock (Wunderlich's syndrome), which was managed by urgent total nephrectomy.
  
  
  METHODS
  A 53 year old female was transferred to the emergency room with progressive acute painful swelling of the left lateral abdominal area, duration of 5h. An emergent ultrasonic examination, revealed a heterogeneous-solid mass with maximum diameter of 23cm, with probable origin from the left kidney. Due to worsening of the clinical status (hypovolemic shock), loss of consciousness and acute drop of haematocrit level to 17.8%, the patient was urgently intubated in the emergency room and transferred to the operating theater. A giant haemorrhagic mass was found originating from the left kidney, which removed en-block with the left kidney. The patient was transferred to the intensive care unit. Her recovery was uneventful. The histopathologic examination revealed a giant renal angiomyolipoma (25×18×8cm) with extensive bleeding.
  
  
  CONCLUSIONS
  Enlarged renal AMLs can rupture. This can be sudden and painful with manifestations of hypovolemic shock. The management of AMLs has been correlated with symptoms. Patients with life-threatening retroperitoneal haemorrhage, require urgent exploration as retroperitoneal bleeding can lead to severe complications, increasing morbidity.
  
  
  CONCLUSIONS
  In case of giant angiomyolipoma with intratumoral haemorrhage, and symptoms of Wunderlich's syndrome, partial or total nephrectomy is a good treatment option in order to save the patient's life.
authors.affiliation: Surgical Department, General Hospital, Kilkis, Greece. Electronic address: pachrono@gmail.com.
authors.forename: Panagiotis Nikolaos
authors.initials: PN
authors.lastname: Chronopoulos
authors.affiliation: Surgical Department, General Hospital, Kilkis, Greece.
authors.forename: Georgios Nikolaos
authors.initials: GN
authors.lastname: Kaisidis
authors.affiliation: Surgical Department, General Hospital, Kilkis, Greece.
authors.forename: Christos Konstantinos
authors.initials: CK
authors.lastname: Vaiopoulos
authors.affiliation: Anaestesiology Department, General Hospital, Kilkis, Greece.
authors.forename: Dragana Milosav
authors.initials: DM
authors.lastname: Perits
authors.affiliation: Intensive Care Unit, Army Hospital 424, Thessaloniki, Greece.
authors.forename: Michail Nikolaos
authors.initials: MN
authors.lastname: Varvarousis
authors.affiliation: Urology Department, Army Hospital 424, Thessaloniki, Greece.
authors.forename: Apostolos Vasilios
authors.initials: AV
authors.lastname: Malioris
authors.affiliation: Pathology Department, General Hospital "Papageorgiou", Thessaloniki, Greece.
authors.forename: Elissabeth
authors.initials: E
authors.lastname: Pazarli
authors.affiliation: Surgical Department, General Hospital, Kilkis, Greece.
authors.forename: Ioannis Konstantinos
authors.initials: IK
authors.lastname: Skandalos
keywords: Giant angiomyolipoma; Hypovolemic shock; Nephrectomy; Retroperitoneal hemorrhage; Wunderlich’s syndrome