Sudden onset flank pain: Spontaneous renal rupture

Undifferentiated abdominal pain is a common condition encountered in the emergency department. While a patient's age, risk factors, and comorbidities often aid in risk stratification and guide emergency department evaluation, atypical presentations of serious disease may still occur suddenly in young otherwise healthy patients.

In this vignette we discuss a case of spontaneous, atraumatic renal rupture with large retroperitoneal hemorrhage (Wunderlich's Syndrome) in a 22year old male.

Emergency physicians regularly encounter uncommon causes of abdominal pain. Wunderlich's syndrome is rare but proper understanding of the disease process will aid in decision making and improve disposition and outcomes for patients. Likely presentations and risk factors for atraumatic renal rupture will be discussed as well as ED management and definitive treatment options.