Postoperative contralateral renal rupture with multisystem complications after surgery for right renal calculi: a rare clinical case report

BACKGROUND: Spontaneous renal rupture (Wunderlich syndrome) is a rare and life-threatening condition, typically occurring in kidneys with pre-existing ipsilateral pathology. The occurrence of spontaneous contralateral renal rupture with multisystem complications shortly after urological surgery is extremely uncommon. This case report describes the diagnosis and treatment of contralateral renal rupture following right renal calculi surgery, complicated by infection, acute respiratory distress syndrome (ARDS), and chylothorax. It also discusses the importance of evaluating subtle contralateral renal abnormalities and employing multidisciplinary team (MDT) management. CASE PRESENTATION: A 52-year-old male patient was admitted for right renal calculi. Preoperative non-contrast CT revealed a mild, atypical hypodense lesion in the left kidney, which was not further characterized preoperatively. On the second day of hospitalization, the patient underwent right kidney surgery. Three days postoperatively, he suddenly developed left flank pain, hypotension, and a drop in hemoglobin levels. Contrast-enhanced CT confirmed spontaneous rupture and massive hemorrhage of the left kidney. Digital subtraction angiography revealed arterial extravasation, and selective embolization was performed. The patient was subsequently transferred to the ICU. He later developed ARDS, co-infection with influenza virus and bacterial/fungal pathogens, and left-sided chylothorax. Through comprehensive treatment including mechanical ventilation, antimicrobial therapy, thoracic drainage, and nutritional support, and under the coordination of the MDT, the patient’s condition gradually improved, and he was eventually discharged after full recovery. CONCLUSION: Even mild or atypical hypodense lesions in the contralateral kidney may indicate potential bleeding risk and should prompt further evaluation with enhanced CT or MRI prior to surgery. Postoperative stress response, inflammation, and hemodynamic fluctuations may trigger rupture of vulnerable pre-existing renal lesions. In patients presenting with flank pain, anemia, and shock after surgery, spontaneous rupture of the contralateral kidney should be highly suspected, and prompt imaging and interventional management are critical. In the presence of multisystem complications such as ARDS, mixed infections, and chylothorax, MDT management is vital for improving patient outcomes.