West Kazakhstan Medical Journal

Published date: Jun 02 2025

Journal Title: West Kazakhstan Medical Journal

Issue title: West Kazakhstan Medical Journal: Volume 67 Issue 2

Pages: 247 - 254

DOI: 10.18502/wkmj.v67i2.16791

Baurzhan Kilibayevkilibayev.baurzhan@bk.ruDepartment of Urology and Andrology, Astana Medical University, Astana

Ulanbek Zhanbyrbekulyulanbek.amu@gmail.comDepartment of Urology and Andrology, Astana Medical University, Astana

Aluadin NurberdiyevAlluadin@mail.ruDepartment of Urology and Andrology, Astana Medical University, Astana

Nurbol Keulimzhayevnurbol_705.90@mail.ruDepartment of Urology and Andrology, Astana Medical University, Astana

Aidana Mustafaaidana.mustafa@nu.edu.kzDepartment of Medicine, School of Medicine, Nazarbayev University, Astana

Angiomyolipoma (AML) is the most common benign mixed mesenchymal tumor of the kidneys, with an incidence of approximately 0.13%, predominantly affecting women. AML consists of abnormal vasculature, smooth muscle cells, and adipose tissue, and can be either isolated or associated with tuberous sclerosis. A 34-yearold woman presented with severe left lower back pain radiating to the peritoneal wall, unresponsive to analgesics. Imaging studies, including ultrasound and contrastenhanced CT, identified a hemorrhaging AML with dimensions of 46x49x42 mm in the left kidney. Due to hypovolemic shock and clinical instability, an emergent left nephrectomy was performed, and the patient was stabilized postoperatively. AMLs are often asymptomatic and discovered incidentally but can present with severe complications such as spontaneous retroperitoneal hemorrhage (Wunderlich’s syndrome). Risk factors for rupture include tumor size greater than 4 cm, multifocality, and tuberous sclerosis. Management strategies vary from conservative monitoring to surgical intervention based on the tumor size and clinical presentation. In emergent cases of acute bleeding, nephrectomy can be a life-saving measure. This case highlights the importance of early recognition and appropriate management of AML complications. In cases of clinical instability due to hemorrhage, prompt surgical intervention is crucial to prevent life-threatening outcomes.

Keywords: angiomyolipoma, kidney neoplasms, retroperitoneal hemorrhage, nephrectomy, tuberous sclerosis

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