Renal rupture and retroperitoneal hematoma in obstetric practice: a case report

Abstract

Spontaneous rupture of the kidney during pregnancy is an uncommon but potentially life-threatening condition that poses significant risks to both the mother and the child. The primary causes of kidney rupture during this period include the rupture of a kidney tumor (such as angiomyolipomas), gestational hydronephrosis, hypertensive disorders, thrombotic microangiopathies, trauma, and kidney infarction. One of the challenges in managing this condition is that the kidney is often not initially suspected as a source of bleeding, leading to a delay in the diagnosis of kidney rupture. This report analyzes a clinical case involving the successful intraoperative verification of renal angiomyolipoma during a cesarean section in a full-term pregnancy. A 32-year-old multiparous patient presented with acute pain in the right hypochondrium and lower back, along with hypotension and tachycardia, in the context of regular labor activity. This clinical presentation was initially misinterpreted as a sign of premature placental abruption. Due to a deterioration in fetal condition, an emergency cesarean section was performed, revealing a retroperitoneal hematoma of unknown origin. Following transfer to a specialized hospital, spiral computed tomography confirmed the diagnosis of a ruptured right kidney, which was verified during surgery. Nephrectomy was subsequently performed, and histological examination revealed the underlying cause to be renal angiomyolipoma. The postoperative recovery was uneventful, and the patient was discharged in satisfactory condition on Day 15 post-surgery. Pregnancy has the potential to prompt the growth of tumors such as angiomyolipoma, thereby increasing the risk of spontaneous rupture, particularly with the onset of labor. While this is a rare complication, it requires an interdisciplinary approach for effective diagnosis and treatment.