Delayed rupture of adrenal grand after trauma: A case report

BACKGROUND: Because adrenal glands are enveloped by Gerota's fascia, spontaneous hemostasis is achieved in most cases of traumatic adrenal injury. For this reason, adrenal injuries are often treated conservatively and rarely present a clinical problem. CASE PRESENTATION: An 85-year-old man. He presented with right adrenal injury due to blunt trauma, fracture of the right transverse process of the 1st-4th lumbar vertebra, and fracture of the right 12th rib. A small amount of hematoma was observed around the adrenal gland, but his vital signs were stable and he was treated conservatively. However, on the 20th day of hospitalization, he developed sudden onset right-sided abdominal pain, hypotension, and restlessness. Contrast-enhanced CT scan revealed hemorrhagic shock due to delayed adrenal rupture, and emergency transcatheter arterial embolization was performed. A pseudoaneurysm formed at the time of injury was considered to have ruptured late. CONCLUSION: Delayed rupture after adrenal injury has never been reported in the past, and is a very rare occurrence. Prompt diagnosis and hemostatic treatment are necessary.