Massive Retroperitoneal Adrenal Hemorrhage Presenting as an Abdominal Emergency

• Published in: Nihon Kyukyu Igakukai Zasshi 1993/06/15, Vol.4(3), pp.256-261
• Main Authors: Niwa, Atsuro, Sumita, Hidenori, Mizutani, Masaru, Narita, Mamoru, Mitsui, Takamori, Oowa, Toshinobu, Sasaki, Shingi
• Format: Article
• Language: English
• Subjects: acute abdomen; adrenal hemorrhage; idiopathic hemorrhage; retroperitoneal hematoma
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.4.256

A 40-year-old woman with lumbago and right flank pain consulted a local physician. Peritonitis was suspected and the patient was referred to our hospital. CT showed a large rihgt retroperitoneal mass with a high density area typical of hematoma. Angiography showed a right adrenal hemorrhage, but no active bleeding. The patient was transfused with 1, 400ml of blood and placed under observation. On day 45, MRI suggested a right adrenal tumor. Surgery was performed on day 51. An enlarged hemorrhagic adrenal gland was removed. Pathologic examination of the surgical specimen revealed no tumor cells or abnormal vascular lesions that could have caused the hemorrhage, so idiopathic adrenal hemorrhage was considered. Massive retroperitoneal adrenal hemorrhage is rare: only 26 cases have been reported in the literature. The main symptoms include upper abdominal pain, flank pain and lumbago. Although adrenal hemorrhage can be diagnosed easily by US, CT or MRI, accurate diagnosis of the etiology of hemorrhage is difficult. If obvious tumorous lesions are not observed, it is recommended to observe the course while providing conservative treatment, rather than simply performing surgery.