Wunderlich Syndrome: A Rare Case of Spontaneous Perinephric Hemorrhage

Wunderlich syndrome is a rare urological emergency characterized by spontaneous, nontraumatic renal hemorrhage into the subcapsular and perirenal spaces. We present the case of a 37-year-old male with end-stage renal disease on hemodialysis, hypertension, and bilateral inguinal hernias who presented with acute chest and abdominal pain, nausea, and vomiting after missing a dialysis session. The initial assessment identified severe anemia necessitating a massive transfusion, and he was subsequently treated for suspected uremic coagulopathy. Imaging with computed tomography angiography (CTA) demonstrated a massive left retroperitoneal hemorrhage. The patient also tested positive for COVID-19, potentially contributing to a complex coagulopathic state. Given ongoing bleeding, he underwent successful renal artery embolization, achieving hemostasis without surgical intervention. This case highlights the importance of early recognition of Wunderlich syndrome in high-risk patients, the diagnostic value of CTA, and the critical role of interventional radiology in management.