Hypovolemic shock due to Wunderlich syndrome (spontaneous renal haemorrhage): a case report and literature review.

Hypovolemic shock due to Wunderlich syndrome (spontaneous renal haemorrhage): a case report and literature review.


  • Andrea Vercelli Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy Via Giuseppe Taverna 49, Piacenza, Italy.
  • Laura Pagani Emergency Department, “Guglielmo da Saliceto” Hospital, Piacenza, Italy Via Giuseppe Taverna 49, Piacenza, Italy.
  • Konstantinos Christodoulakis Urology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Gennaro Marcello Urology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Marcello Petrini Radiology Unit, Department of Radiological Functions, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Emanuele Michieletti Radiology Unit, Department of Radiological Functions, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Chiara Celaschi Anatomical Pathology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
  • Gianfranco Cervellin Academy of Emergency Medicine and Care, Pavia, Italy
  • Erika Poggiali .


Wunderlich syndrome, Lenk’s triad, flank pain, renal haemorrhage, haemorrhagic shock, hypovolemic shock, acute renal injury.


Wunderlich syndrome (WS) or spontaneous renal haemorrhage is a rare and life-threatening condition often leading to haemorrhagic shock. WS is characterized by an acute onset of non-traumatic subcapsular and perirenal haematoma formation due to several causes, including neoplasms, cystic rupture, vasculitis, coagulopathies, and infections. The classical presentation includes acute flank or abdominal pain, a palpable flank mass and hypovolemic shock (Lenk’s triad). Nausea, vomiting, fever, and haematuria can also be present. Computed tomography angiography is mandatory to localize the source of haemorrhage. Super-selective embolization can be performed to stop bleeding, while surgery is reserved to haemodynamic unstable patients and neoplastic cases. We describe a case of WS in a 79-year-old male patient, who rapidly developed hypovolemic shock requiring urgent nephrectomy.


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How to Cite

Vercelli A, Pagani L, Christodoulakis K, Marcello G, Petrini M, Michieletti E, et al. Hypovolemic shock due to Wunderlich syndrome (spontaneous renal haemorrhage): a case report and literature review. Acta Biomed [Internet]. 2023 Jun. 14 [cited 2024 Jul. 22];94(3):e2023073. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/14087