Spontaneous Retroperitoneal Hemorrhage from the Rupture of Renal Angiomyolipoma: A Case Report and Management Challenges

Angiomyolipoma (AML) is the most common benign mixed mesenchymal tumor of the kidneys, with an incidence of approximately 0.13%, predominantly affecting women. AML consists of abnormal vasculature, smooth muscle cells, and adipose tissue, and can be either isolated or associated with tuberous sclerosis. A 34-yearold woman presented with severe left lower back pain radiating to the peritoneal wall, unresponsive to analgesics. Imaging studies, including ultrasound and contrastenhanced CT, identified a hemorrhaging AML with dimensions of 46x49x42 mm in the left kidney. Due to hypovolemic shock and clinical instability, an emergent left nephrectomy was performed, and the patient was stabilized postoperatively. AMLs are often asymptomatic and discovered incidentally but can present with severe complications such as spontaneous retroperitoneal hemorrhage (Wunderlich’s syndrome). Risk factors for rupture include tumor size greater than 4 cm, multifocality, and tuberous sclerosis. Management strategies vary from conservative monitoring to surgical intervention based on the tumor size and clinical presentation. In emergent cases of acute bleeding, nephrectomy can be a life-saving measure. This case highlights the importance of early recognition and appropriate management of AML complications. In cases of clinical instability due to hemorrhage, prompt surgical intervention is crucial to prevent life-threatening outcomes.