Spontaneous Circumrenal Haematoma
Authors: K. W. Martin
Journal: BMJ (1949)

The term "spontaneous circumrenal haematoma" is self- explanatory and excludes, by definition, cases of traumatic origin.The condifion is said to be a rare one, though I have had to deal with two cases in the past nine years.These two cases and a short review of the subject are thought to be worth publishing, as no mention is made of the condition in most of the standard surgical textbooks, and no description of it had appeared in any English journal until that of Heritage in 1934.The condition is referred to by Hamilton Bailey (1944) and in American papers under the title of spontaneous perirenal haematoma.At risk of seeming pedantic, however, the Graeco-Roman bastardy of the word " perirenal " should condemn it.The condition is probably not as rare as the literature would suggest; it may possibly be the underlying lesion in such labels as " retroperitoneal sarcoma " and " retroperitoneal haematoma of obscure aetiology."Case 1A youth aged 18 was suddenly taken ill at sea with abdominal pain and vomiting on Nov. 14, 1945.There was no history of trauma.Next morning his condition was worse.He had a furred tongue and a weak thready pulse of 130; his tem- perature was 1030 F. (39.4'C.).There was extreme tender- ness and rigidity in the right loin and right iliac fossa.Exami- nation of the urine, including centrifugalization and microscopy, was negative.A diagnosis of retrocaecal appendicitis with generalized peritonitis was made; he was shipped ashore and admitted to the Calvary Hospital, Hobart, Tasmania.He was seen by two surgeons, who agreed with the diagnosis, and immediate operation was undertaken.At operation the appendix was normal, but a large retro- peritoneal haematonr.a,which appeared to surround the kidney, was found in the right paracolic gutter.The incision was extended and the swelling was being explored further when the anaesthetist reported that the patient was in extremis and the abdomen had to be quickly closed.He was given a blood transfusion of 4 pints (2.2 litres) and his condition improved considerably.Ten hours after the first operation the wound was reopened.This approach, rather than a lumbar incision, was chosen to enable the presence of a left kidney and its condition to be ascertained.The ascending colon was mobilized, and after mopping out blood clot a transperitoneal nephrectomy was carried out.After this operation he made a rapid and uninterrupted recovery.Pathological Report.-"Thekidney is lobulated, resembling the foetal type, with dilated pelvis and calices.No visible inflammatory reaction in the pelvic cavity.A haemorrhagic area over the hiluni shows only a layer of tissue between the pelvis and the exterior.Sections show widespread interstitial nephritis, with areas of small round-cell infiltration scattered through the renal tissue.At the site of haemorrhage there is complete replacement of the renal tissue by inflammatory scar ti6sue."Pyelograms. taken two and six months after operation, showed a large left kidney and large pelvis with good secretion.Now, three years after, the patient is perfectly fit and still serving as a regular officer in one of the armed Forces.