A CASE OF INTRAPERITONEAL RUPTURE OF A GIANT RENAL ANGIOMYOLIPOMA

SAME CONSIDERATIONS OF SELECTIVE TRANSCATHETER ARTERIAL EMBOLIZATION

Abstract

A 40-year-old woman with tuberous sclerosis and bilateral renal angiomyolipomas who was followed in the clinic was found that the angiomyolipomas increased to be 25×20×11cm in size on the left and 20×20×11cm on the right. And she had experienced intraperitoneal rupture of the left renal angiomyolipoma three times, when she developed sudden onset of severe abdominal pain, abdominal distension and shock. At the third rupture, she could not recovered from the shock state by the rapid transfusion. Therefore we performed an immediate selective transcatheter arterial embolization with coiles to the posterior branch of the left renal artery which fed the major part of the tumor 25×14×11cm in size having many pseudoaneurysms. After that the blood pressure became stable. Following the emborization, high fever and abdominal pain persisted for two weeks. Three months after the operation, the left renal tumor was decreased to 17×17×8cm in size, and until now no signs of rupture have been demonstrated.
In domestic cases in the literature including this case, selective transcatheter arterial embolization for renal angiomyolipoma was successful in hemostasis of the tumor. No re-rupture occurred and shrinkage of the tumors was recorded in all cases in which clinical courses were described. It is suggested that the transcatherter arterial embolization is an excellent therapy to hemostasis and tumor shrinkage for ruptured renal angiomyolipoma.