[Spontaneous perirenal hematoma: diagnostic and therapeutic approach]

Spontaneous perirenal haematomas are relatively rare. The authors report 6 recent cases and try to propose a diagnostic and therapeutic strategy based on the aetiology.

From January 1993 to May 1995, 6 patients between the ages of 36 and 61 years were admitted to hospital for spontaneous perirenal haematoma, presenting in the form of acute lumbar pain associated, in one half of cases, with signs of internal bleeding.

In each case, CT examination allowed precise assessment of the haematoma, but the aetiology was determined preoperatively in only 3 out of 6 patients, corresponding to a neoplastic lesion in each case (1 corticoadrenaloma, 1 adenocarcinoma, 1 angiomyolipoma). All patients were operated (3 radical nephrectomies, 2 haemostatic nephrectomies, 1 drainage of the haematoma with biopsies). No cause was found in 2 cases.

Spontaneous perirenal haematomas essentially raise the problem of the aetiological diagnosis, but can sometimes be inadequate. Arteriography is useful when CT scan is negative or in the case of vascular disease. The therapeutic attitude, nephrectomy or conservative treatment remains controversial, but in view of the frequency of renal neoplastic lesions, the authors recommend nephrectomy at the slightest doubt concerning renal integrity. When no cause can be found, the assessment must be completed postoperatively with long-term, close surveillance, due to the risk of an undiagnosed neoplastic lesion.