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A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a
 rare and usually asymptomatic vascular lesion which in most of the cases
 thrombose spontaneously, but at same time it can be a source of
 life-threatening hemorrhage and shock. Today, these pseudoaneurysms are
 discovered with increasing frequency due to unrelated abdominal imaging or
 on screening work-ups for hypertension, as well as widespread use of
 angiography. Typically, they are seen in patients after trauma,
 inflammation, or renal surgery or biopsy. Case outline. In our case, a
 52-year-old male patient with no prior history of surgery, significant
 abdominal trauma and systemic disease, presented with left flank pain and
 signs of hypovolemic shock that manifested before the admission in the
 surgical emergency room. The CT scan promptly demonstrated rupture of large
 retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The
 angiography confirmed the rupture of the renal artery pseudoaneurysm. The
 patient had the urgent operation. A life-saving nephrectomy was performed
 while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated.
 The fourteen days after surgery the patient was discharged fully recovered,
 with normal diuresis and serum levels of creatinine and urea within
 referential values. During the period of hospitalization, he was diagnosed
 and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the
 following hemorrhage into the intraperitoneal cavity and retroperitoneum is
 a life-threatening condition, as proven with this case in which hypovolemic
 shock manifested before the admission. We would like to highlight the
 importance of high blood-pressure control and the importance of regular
 check-ups.