Cough-Induced Spontaneous Rupture of the Kidney Secondary to Anticoagulant Therapy: Wunderlich’s Syndrome

Spontan böbrek veya diğer organ rüptürleri antikoagülanlara sekonder çok nadir bildirilmiştir. Klinik tabloda akut flank/karın ağrısı, hematüri, hipotansiyon ve şok görülebilir. Öksürük esnasında karın içi basıncının artışına bağlı oluşabilir. Rüptürün en sık sebebi anjiomyolipomlar gibi böbrek tümörleridir. Diğer sebepler arasında uzun süreli diyaliz, arteritler ve ateroskleroz sayılabilir. Eğer agresif tedavi edilmezse hayatı tehdit eden bir durumdur. Hemoraji kendini sınırlarsa konservatif yaklaşılabilir. Anjiyografik selektif embolizasyon ve parsiyel/total nefrektomi diğer tedavi seçenekleridir. Literatürde buna benzer bir olgu bildirilmiştir. Bizim olgumuzda takip sonrası total nefrektomi yapılsa da, bu yeterli olmamıştır

Antikoagülan Tedaviye Sekonder Öksürüğün İndüklediği Spontan Böbrek Rüptürü: Wunderlich Sendromu

Spontaneous renal or other organ ruptures secondary to anticoagulants have rarely been reported. The clinical features of renal rupture include acute flank/abdominal pain, haematuria, hypotension and shock. It can occur due to increased intraabdominal pressure during coughing. Rupture is most commonly caused by renal tumors such as angiomyolipomas. In the literature, other known causes are long-term haemodialysis, arteriosclerosis or arteritis. Wunderlich’s syndrome is an extremely dangerous complication that may cause death if not treated intensively. If the haemorrhage is self-limiting and the patient is responsive to fluid replacement, the patient can be managed conservatively. Selective angiographic embolization and emergency nephrectomy (partial or total) are the treatment options. In the literature, we found only one case that was presented as spontaneous non-traumatic renal rupture associated with coughing. In our case, total nephrectomy had to be performed, but it was not adequate

Kaynakça

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