Retroperitoneal bleeding caused by spontaneus rupture of renal angiomyolipoma following cesarean section treated with selective embolisation

Authors: J. Harašta 1;  K. Huml 2
Authors‘ workplace: Gynekologicko-porodnické oddělení Nemocnice Šternberk, primář MUDr. M. Vaca, MBA 1;  Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. 2
Published in: Ceska Gynekol 2019; 84(4): 298-302
Category: Case Report


Objective: To describe management of a spontaneus rupture of renal angiomyolipoma after cesarean section.

Design: Case report.

Setting: Department of Gynaecology and Obstetrics, Hospital Šternbek; Department of Obstetrics and Gynaecology, Palacky University and University Hospital, Olomouc.

Case report: 29-year-old patient underwent acute cesarean section at 35 weeks of gestation for pPROM, placenta praevia marginalis, suspicion of placenta accreta by ultrasound and MRI and transverse position of the fetus. The next morning was found out a spontaneus rupture of renal angiomyolipoma causing progressive anemisation. We describe the following management.

Conclusion: Incidention of tumors complicating gravidity may occur more often due to changes in population characteristics. Methods of interventional radiology are ordinarily used for severe hemorrage postpartum or for prophylactic occlusion of illiac arteries before cesarean section with morbidly adherent placenta. We show here usage of selective embolisation in not so common obstetrical complications.


bleeding – embolisation – angiomyolipoma – placenta praevia – cesarean section – tamponade


1. Angileri, SA., Mailli, L., Raspanti, C., et al. Prophylactic occlusion balloon placement in internal iliac arteries for the prevention of postpartum haemorrhage due to morbidly adherent placenta: short term outcomes. La Radiologia Medica, 122(10), p. 798–806.

2. Ao, L., Ogasahara, E., Okuda, Y., Hirata, S. Spontaneous rupture of renal angiomyolipoma during pregnancy. BMJ Case Reports, 2017, 1(6), nr. 217284.

3. ČSÚ. Průměrný věk žen při narození dítěte v letech 1950–2016. [online]. 2017. [2017-12-06]. [cit. 2018-09-23]. Dostupné na:–2016.

4. Davis, NF., Kelly, R., Lee, MJ., Mohan, P. Selective arterial embolisation of bilateral angiomyolipomata in a symptomatic pregnant female. BMJ Case Reports, 2013, 11(20), nr. 009256.

5. Delotte, J., Novellas, S., Koh, C., et al. Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage. Eur J Obstet Gynecol Reprod Biol, 2009, 145(2), p. 129–132.

6. Fakultní nemocnice v Olomouci. Radiologická klinika, Oddělení intervenční radiologie, dokumentace.

7. Hassanpour, A., Ahmed, F., Yeganeh, BS., et al. Spontaneous rupture of renal cell carcinoma in pregnancy, surgical management with fetal preservation: a case report. Urol J, 2018, 15(6), p. 400–402.

8. Chronopoulos, PN., Kaisidin, GN., Vaiopoulos, CK., et al. Spontaneous rupture of a giant renal angiomyolipoma-Wunder­lich‘s syndrome: Report of a case. Inter J Surg Case Reports, 2016, 19, p. 140–143.

9. Idilman, IS., Vesnic, S., Cil, B., Peynircioglu, B. Giant renal artery pseudoaneurysm caused by rupture of renal angiomyolipoma following pregnancy: endovascular treatment and review of the literature. Saudi J Kidney Dis Transplantat, 2014, 25(2), p. 385–389.

10. Kawaciuk, I. Nádory ledvin. Urologie. Galén, 2009, 340 s.

11. Kira, S., Sewada, N., Miyamato, T., et al. Hemorrhagic renal angiomyolipoma in pregnancy effectively managed by immediate cesarean section and elective transcatheter arterial embolization: a case report. J Endourol Case Reports, 2016, 2(1), p. 65–67.

12. Klézl, P., Richterová, R., Štanc, O., a kol. Objemný angiomyolipom pravé ledviny u mladé ženy. Urolog Listy, 2013, 11(4), s. 45–48.

13. Kontos, S., Politis, V., Fokitis, I., et al. Rupture of renal angiomyolipoma during pregnancy: a case report. Cases J, 2008, 1, p. 245.

14. Lim, CH., Mulvin, D. Embolisation of bleeding renal angiomyolipoma in pregnancy. Open J Urol,. 2011, 1, p. 25–27.

15. Lopes, MM., Proenca, SMS., Pereira, MIN., et al. Spontaneous rupture of renal angiomyolipoma during pregnancy. Brazil J Gynecol Obstet, 2014, 36(8), p. 377–380.

16. Mishra, VV., Mistry, K., Nanda, S., et al. Successful pregnancy outcome in a patient with solitary kidney affected by angiomyolipoma: a rare case. J Clin Diag Res, 2016, 10(10), p. 6–7.

17. Myoen, S., Mitsuzuka, K., Saito, H., et al. Spontaneous rupture of a renal angiomyolipoma at 25 weeks of pregnancy treated with transarterial embolization: A case report and review of the literature. Inter J Urol, 2015, 20, p. 710–712.

18. Ordoñez, CA., Manzano-Nunez, R., Parra, MW., et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg, 2018, 85(5), p. 809–818.

19. Preece, P., Mees, B., Norris, B., et al. Surgical management of haemorrhaging renal angiomyolipoma in pregnancy. Inter J Surg Case Reports, 2015, 7, p. 89–92.

20. Rana, MA., Mady, AF., Jakaraddi, N., et al. Not all acute abdomen cases in early pregnancy are ectopic; expect the unexpected: renal angiomyolipoma causing massive retroperitoneal haemorrhage. Case Reports Critical Care, 2016, nr.5643470.

21. Spreu, A., Abgottspon, F., Baumann, MU., et al. Efficacy of pelvic artery embolisation for severe postpartum hemorrhage. Arch Gynecol Obstet, 2017, 296(6), p. 1117–1124.

22. Ünlü, C., Lamme, B., Nass, P., Bolhuis, HW. Retroperitoneal haemorrhage caused by a renal angiomyolipoma. Emergency Med J, 2006, 23, p. 464–465.

23. Urciuoli, P., D‘Orazi, V., Livadoti, G., et al. Treatment of renal angiomyolipoma: surgery versus angioembolization. Il Giornale di Chirurgia, 2013, 34(11/12), p. 326–331.

24. ÚZIS. Novotvary 2015 ČR. [online]. [cit. 2018-09-23]. Dostupné na:

25. Wang, C., Li, X., Peng, L., et al. An update on recent develop­ments in rupture of renal angiomylipoma. Medicine. 2018, 97(16), nr. 0497.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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