Rare Case of Spontaneous Renal Vessel Rupture caused by severe vomiting in early pregnancy: A report

Spontaneous renal vessel rupture is an uncommon but severe clinical emergency. The symptoms and signs of this condition can be subtle and not easily recognized during pregnancy, compounded by limited diagnostic methods that may obscure detection. Consequently, early renal rupture is difficult to identify, which can lead to misdiagnosis and adverse outcomes. The paper by Jiang Deng, Hubei No. 3 People's Hospital of Jianghan University, Wuhan, China, and colleagues seeks to enhance clinicians' awareness of this rare condition and decrease the likelihood of clinical misdiagnosis.

The case concerns a woman aged 23 and 11 weeks pregnant who developed severe right lumbar and abdominal pain for 14 hours after severe nausea, vomiting, and paroxysmal intensification.

An external hospital's color ultrasound identified an abnormal shadow in the right kidney region, suggesting hydronephrosis, renal calculus, and right ureteral dilation. Despite symptomatic treatments like spasmolytics and infusions, the patient's symptoms persisted, leading to admission to the urology department. The patient reported no history of urinary surgery or abdominal trauma.

Upon admission, the patient received symptomatic treatments, including oxygen monitoring, anti-infection drugs, spasmolytics, analgesics, and strict bed rest. However, symptoms persisted, prompting an abdominal CT scan 4 hours later. The scan suggested a possible rupture of the right kidney, with exudation into the retroperitoneum and pelvic cavity, and a right perirenal hematoma (5.0 × 7.8 × 8.8 cm).

A follow-up blood test showed elevated white blood cells (13.48 × 10^9/L), low hemoglobin (75 g/L), and impaired renal function (creatinine 129.11 µmol/L, glomerular filtration rate 48.96 mL/min). The patient received a red blood cell transfusion, increasing hemoglobin to 77 g/L.

Eighteen hours later, an enhanced CT revealed a rupture in the right renal artery's inferior trunk branch and an expanded hematoma, with more intra-abdominal and bilateral pleural fluid. Conservative treatments failed to stabilize the patient, leading to emergency renal artery embolization. A week later, a CT showed renal necrosis, resulting in a right nephrectomy.

In this case, spontaneous renal vascular rupture and hemorrhage diagnosis were confirmed. Following conservative treatment such as fluid replenishment, hemostasis, and blood transfusion, the patient was given an emergency renal artery embolization due to unstable hemodynamics during treatment and poor conservative treatment effect. A nephrectomy was performed following a 1-week follow-up for renal necrosis.

"To prevent missed or incorrect diagnoses, patients experiencing abdominal pain from severe vomiting during pregnancy should be closely monitored. Treatment should be personalized to ensure the safety of both mother and child. Spontaneous renal vessel rupture should be considered in the differential diagnosis," the researchers concluded.

Reference:

Deng J, Huang H, Ma J, Wei H, Qu X, Hu Z, Zeng H, Zhou J. Case report: A case of renal vessel rupture caused by severe vomiting in early pregnancy. Medicine 2024;103:30(e39025). Received: 18 April 2024 / Accepted: 1 July 2024 http://dx.doi.org/10.1097/MD.0000000000039025