[Massive bilateral adrenal hemorrhage after conservative tumor surgery in the isthmus of a horseshoe kidney].

OBJECTIVE: To present a fatal case of massive bilateral suprarrenal haemorrhage (MBSH) after partial nephrectomy.

CLINICAL CASE: An 82 year old male treated with oral anticoagulants was diagnosed by means of CT scan and arteriography of having an avascular tumor located at the isthmus of a horseshoe kidney. A tumorectomy with safety surgical margins was performed; It was diagnosed of having a renal adenocarcinoma, which was almost completely necrotic. During the postoperative period, the patient presented abdominal pain, nausea, fever, hypotension and severe respiratory distress. Biochemical studies showed mild hyponatremia and azotemia, accompanied by anemia, leucocytosis and thrombocytosis. An abdominal CT scan demonstrated a MBSH, which produced the patients death soon afterwards.

DISCUSSION: Tumoral pathology of horseshoe kidneys presents important topographic and anatomopathologic differences with respect to non-fused kidneys. MBSH is a rare complication of many stress processes especially if an anticoagulant treatment coexists. The treatment has to be initiated as soon as we suspect MBSH, which should be confirmed by hormonal determinations and/or the presence of hyperdense suprarenal lesions at the CT scan.