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

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Andrea Vercelli
Laura Pagani
Konstantinos Christodoulakis
Gennaro Marcello
Marcello Petrini
Emanuele Michieletti
Chiara Celaschi
Gianfranco Cervellin
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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