A 40-year-old man with no morbid history.
Adult Emergency Unit at 01:00 hours due to sudden and intense left lumbar pain without other symptoms.
Stable hemodynamics.
On examination, she was pale and sweaty.
There was no response to analgesia so it was decided to hospitalize.
Among his admission tests: hematocrit 33%, leukocyte count 27,000 x mm3.
Simple renal radiography: blurring of the left psoas line.
At 16:00 h, the patient presented stable hemodynamics, persistent pain and stiffness.
Causes fell to 27%.
Urine sedimentation with erythrocytes 1-3 per field, leukocytes 5-6 per field, hyaline and fine granular casts.
Abdominal computed tomography (CT) showed a hypodense lesion of the left kidney, with active bleeding and extensive occupation of the left retroperitoneum.
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At 19:00 he presented shock.
Surgical exploration was decided.
A mid-upper and infra umbilical approach was performed.
A hemoperitoneum of approximately 500 mi was found.
Left colon was displaced medially by extensive left retroperitoneal hematoma.
A transmesenteric approach was used to transiently identify and isolate the left renal vessels.
Mattox maneuver allowed evacuating a left retroperitoneal hematoma of approximately 2,000 mi.
The left kidney presented a saccadic lesion in the middle segment, with an afractuous edge and diameter of approximately 5 cm, with incoercible bleeding, so it was decided to perform a nephrectomy level ligating the left vessels.
The patient was in shock, with evident coagulation disorders.
The loop edema did not allow primary closure, so it was left with contained laparostomy and placed in the Intensive Care Unit for 48 hours, with posterior closure without incidents.
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Histopathological examination revealed a hemorrhagic renal angiomyolipoma.
The patient had a good outcome later.
His hematocrit was 30% and his renal function remained within normal ranges.
The imaging study ruled out remaining kidney lesions.
She was discharged after 10 days because she lived far from town.
