Spontaneous ruptures of renal tumors

Abstract

Spontaneous retroperitoneal hemorrhages are a rare but severe complication of retroperitoneal organs and tissues disorders. For the last five years we treated 10 patients (7 females and 3 males) with spontaneous subcapsular or paranephral hematoma resultant from renal tumor rupture. Morphologically, 4 tumors were renal angiomyolipoma and 6 tumors - renal cell carcinoma. Most characteristic symptoms consisted in acute lumbar pain on the affected side (100%) and the absence of macrohematuria in all the patients. Marked hemodynamic disorders of a hypotonic type were observed in 50% patients (4 patients lost consciousness). Left kidney tumor ruptures were more frequent (70%). An accurate preoperative diagnosis was made in 70% cases with application of ultrasonic investigation, computed tomography, MR imaging. Of 4 patients with renal angiomyolipoma, conservative surgery (enucleation, enucleoresection) was conducted in 3(75%) patients. Of 6 patients with renal cell carcinoma, tumor removal with preservation of the kidney was feasible only in 1 (16.6%) patient, in the rest 5 patients radical nephrectomy was made. In 2 patients it was combined with venacavathrombectomy. Thus, patients with spontaneous rapture of renal tumors are characterized by absence of macrohematuria, prevalent location of the tumor on the left and in the middle segment of the kidney (90%), high diagnostic effectiveness of ultrasonography, no rise in local tumor recurrence consequently to rapture of the tumor tissue.