A case of colonoscopy-induced Wunderlich's syndrome in a hemodialysis patient: coincidence or association?

Abstract Wunderlich syndrome, or spontaneous renal hemorrhage (SRH), is a rare condition encountered in patients undergoing chronic hemodialysis (HD) usually attributed to acquired cystic kidney disease (ACKD) among other causes. In the literature, colonoscopy is associated with splenic injuries, and renal hemorrhage has not been previously described. Management can range from conservative treatment to angiographic embolization or exploration and nephrectomy. Here we report an unusual case of a 54-year-old woman HD patient who presented with SRH within a few days of colonoscopy. The reason of SRH was rupture of an ACKD cyst. We assumed that colonoscopy was a provoking factor and elaborated hypotheses for its etiopathogenesis. The patient underwent successful left nephrectomy. The importance of this case lies in the fact that colonoscopy is not always an innocent procedure in HD patients, and could be complicated by renal cyst hemorrhage.摘要 温德立希综合征（Wunderlich syndrome），亦称自发性肾出血（spontaneous renal hemorrhage, SRH），是一种罕见病症，常见于接受慢性血液透析（chronic hemodialysis, HD）的患者，其主要病因除其他因素外，多与获得性肾囊性疾病（acquired cystic kidney disease, ACKD）相关。现有医学文献中，结肠镜检查仅被证实与脾损伤存在关联，此前尚未见其诱发肾出血的报道。临床治疗方案可涵盖保守治疗、血管造影栓塞术，或剖腹探查联合肾切除术。本文报告一例特殊病例：一名54岁女性慢性血液透析患者，在接受结肠镜检查数日后出现自发性肾出血，致病诱因为获得性肾囊性疾病的囊肿破裂。我们推测结肠镜检查为本次发病的诱发因素，并针对其发病机制提出了相关假说。该患者最终成功接受左肾切除术。本病例的重要意义在于，结肠镜检查并非慢性血液透析患者的绝对无害操作，其可能引发肾囊肿出血这一并发症。