A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Abstract

Introduction The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy.

Case outline In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission to the surgical emergency room. The CT scan promptly demonstrated rupture of a large retroperitoneal hematoma with massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient underwent urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. Fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed with and treated for hypertension.

Conclusion Rupture of pseudoaneurysms followed by hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case, in which hypovolemic shock manifested itself before the admission. We would like to highlight the importance of high blood pressure control and the importance of regular check-ups.

Keywords: renal artery pseudoaneurysm; rupture; life-threatening procedure