Spontaneous subcapsular or perirenal haemorrhage caused by renal tumours -A urological emergency

Objective: Spontaneous perirenal haemorrhage is a rare abdominal emergency most commonly caused by solid renal tumours. The aim of this study was to e valuate the efficacy of different diagnostic methods and treatment modaliti es. Material and Methods: A total of 9 patients (5 women and 4 men) with sp ontaneous subcapsular or perirenal haemorrhage caused by renal tumours were treated at two Finnish central hospitals over a-period of 20 years. Result s and Conclusions: All the patients presented with flank pain, often severe and associated with a palpable mass and a reduced haemoglobin concentratio n. Ultrasonography was abnormal in all cases where it was used, but was abl e to show the tumour and haemorrhage correctly in only one case (13%). Comp uted tomography had a sensitivity of 71%. Seven patients underwent extrafas cial nephrectomy (5 renal cell cancers, 1 malignant oncocytoma and 1 angiom yolipoma) and two with known tuberous sclerosis and bilateral renal angiomy olipomas were treated by superselective embolization. As these few cases we re all individual and were collected over a long period of time, general st atements about diagnosis and treatment must be approached critically. It ma y be concluded, however, that spontaneous perirenal haemorrhage is often a surgical emergency necessitating great efforts in terms of diagnosis and tr eatment. Computed tomography should be performed on all patients nowadays. If the bleeding is caused by a malignant tumour, extrafascial nephrectomy i s the treatment of choice. For those with benign tumours selective emboliza tion should be used.