Wunderlich Syndrome Triggered by Deadlifting: A Rare Case Report of Spontaneous Renal Haemorrhage.

BACKGROUND: Wunderlich syndrome (WS) is a rare phenomenon. It was first described by Carl Wunderlich in 1857 as a clinical picture of spontaneous renal bleeding with dissection of blood into either or both the subcapsular and perinephric spaces. Tumours, vascular malformations, coagulopathy and inflammatory states have been shown to be aetiological factors, yet up to 10% of cases remain idiopathic. WS is usually diagnosed on CT imaging due to the variable history and signs on examination which can mimic many other abdominal conditions. Management strategies include conservative treatment, embolisation and surgical nephrectomy.

CASE PRESENTATION: A 37-year-old female presented to the emergency department with acute onset severe right flank pain after performing deadlift exercises in the gym. She collapsed on arrival. Clinical observations and blood results were indicative of haemorrhagic shock. Computed tomography (CT) with angiography demonstrated an acute right renal haemorrhage with active extravasation and the formation of a large perirenal haematoma. Blood products and vasopressors were administered to resuscitate the patient. Definitive management with embolisation was undertaken by the interventional radiology team.

CONCLUSION: WS is a rare diagnosis that should be considered in patients presenting with flank pain and evidence of haemorrhagic shock. Weightlifting can act as a trigger for this condition. Early recognition and intervention can enable successful resuscitation and definitive treatment with minimally invasive embolisation.