Life-threatening Wunderlich's syndrome with concurrent clopidogrel use

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Spontaneous non-traumatic renal hemorrhage, or Wunderlich's syndrome, is a rare clinical presentation.
• This condition can lead to significant morbidity and mortality if not managed promptly.
• Antiplatelet medications like clopidogrel may increase the risk of bleeding events.

Observation:

• A 63-year-old male patient on clopidogrel presented with hemodynamic instability.
• The patient was diagnosed with spontaneous non-traumatic renal hemorrhage.
• Imaging revealed active bleeding from multiple distinct subsegmental renal vessels.

Findings:

• Angioembolization was performed to identify and treat the source of bleeding.
• Successful hemostasis was achieved through the placement of coils in the affected vessels.
• The patient's hemodynamic status stabilized post-procedure.

Implications:

• This case highlights the successful endovascular management of a rare and potentially fatal condition.
• Angioembolization with coil placement is an effective minimally invasive treatment for spontaneous renal hemorrhage.
• Maintaining near-normal renal function post-intervention is achievable.