Wunderlich’s syndrome secondary to anticoagulant therapy

A 62-year-old woman with complaints of a left iliacac fossa radiatig to left renal fossa. There was no evidence of traumatic injury. The patient reported a history of atrial fibrillation treated with anticoagulant drug. The laboratory tests showed a hemoglobin level of 72 g/l and Hematocrit level of 28 %. Coagulation status: INR = 4.54. We performed CT without and with iodinated contrast in arterial and late phases. A subcapsular and retroperitoneal hematoma were appreciated. with extravasation of the contrast by active bleeding at three points, two in the upper third of the kidney and one in the lower third. The patient underwent arteriography with embolization of two subcapsular segemnterial arteries of the upper group while was decided a conservative management of the inferior group artery.

Wunderlich’s syndrome is a spontaneous non-traumatic bleeding confined to the subcapsular and/or perinephric spaces in patients with no known underlying cause and constitutes an emergency medical condition. Possible causes include benign and malignant renal tumors vasculitis, blood discrasias and anticoagulant agents, renal stone disease, arteriovenous malformations and fistulas, venous thrombosis or rupture of renal artery/intraparenchymal aneurysm

Wunderlich syndrome refers to spontaneous non-traumatic renal bleeding into the subcapsular and/or perirenal space. Anticoagulation is an infrequent etiological cause of Wunderlich syndrom.

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