{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:35:00Z","timestamp":1770226500752,"version":"3.49.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gyeongsang National University Changwon Hospital","award":["GNUCHBRIF-2024-01"],"award-info":[{"award-number":["GNUCHBRIF-2024-01"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Wunderlich syndrome (WS) is a rare clinical condition characterized by spontaneous, non-traumatic renal hemorrhage. Although secondary infection of a renal hematoma has occasionally been reported, progression to a perinephric abscess with fistula formation to the descending colon has not been previously documented. We present a unique case of idiopathic WS in a 61-year-old diabetic woman with poorly controlled blood sugar who developed a spontaneous left subcapsular hematoma without an identifiable etiology. During hospitalization, follow-up contrast-enhanced computed tomography (CECT) revealed interval enlargement of the hematoma with new peripheral enhancement, consistent with abscess formation. Percutaneous catheter drainage confirmed secondary infection. Despite initial clinical stabilization, subsequent computed tomography (CT) demonstrated intralesional gas and progressive inflammatory changes involving the adjacent descending colon. A catheter tubogram confirmed a fistulous connection between the abscess cavity and the descending colon. The patient underwent fecal diversion with ileostomy, in addition to targeted antimicrobial therapy and image-guided drainage. Serial imaging over the following weeks demonstrated progressive resolution of both the abscess cavity and fistula tract, allowing catheter removal and discharge in a stable condition 70\u202fdays after hospitalization. This case highlights that even idiopathic WS may evolve into severe infectious complications, particularly in individuals with risk factors such as long-standing diabetes mellitus with suboptimal glucose control. Physicians should be aware that WS can be complicated by secondary bacterial infection, leading to abscess formation and fistula development between the abscess and the colon. Prompt and accurate diagnosis, along with appropriate management, is essential for resolving these complications.<\/jats:p>","DOI":"10.3389\/fmed.2026.1575103","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T05:34:10Z","timestamp":1770183250000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Idiopathic Wunderlich syndrome complicated by a perinephric abscess with fistula formation to the descending colon"],"prefix":"10.3389","volume":"13","author":[{"given":"Tae Won","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Changwon Hospital","place":["Changwon, Republic of Korea"]},{"name":"Department of Internal Medicine, Gyeongsang National University College of Medicine","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunjin","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Changwon Hospital","place":["Changwon, Republic of Korea"]},{"name":"Department of Internal Medicine, Gyeongsang National University College of Medicine","place":["Jinju, Republic of Korea"]},{"name":"Institute of Health Science, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ha Nee","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Hospital","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sehyun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Hospital","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seunghye","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Hospital","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Se-Ho","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University College of Medicine","place":["Jinju, Republic of Korea"]},{"name":"Institute of Health Science, Gyeongsang National University","place":["Jinju, Republic of Korea"]},{"name":"Department of Internal Medicine, Gyeongsang National University Hospital","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Jun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gyeongsang National University Changwon Hospital","place":["Changwon, Republic of Korea"]},{"name":"Department of Internal Medicine, Gyeongsang National University College of Medicine","place":["Jinju, Republic of Korea"]},{"name":"Institute of Health Science, Gyeongsang National University","place":["Jinju, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1053\/crad.2002.0981","article-title":"W\u00fcnderlich\u2019s syndrome: causes, diagnosis, and radiological management","volume":"57","author":"Albi","year":"2002","journal-title":"Clin Radiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"rjs015","DOI":"10.1093\/jscr\/rjs015","article-title":"A tale of W\u00fcnderlich syndrome","volume":"2012","author":"Wang","year":"2012","journal-title":"J Surg Case Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"bcr2012006280","DOI":"10.1136\/bcr-2012-006280","article-title":"Wunderlich\u2019s syndrome (spontaneous renal haemorrhage)","volume":"2012","author":"Ahmad","year":"2012","journal-title":"BMJ Case Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e220172","DOI":"10.1148\/rg.220172","article-title":"Wunderlich syndrome: comprehensive review of diagnosis and management","volume":"43","author":"Shah","year":"2023","journal-title":"Radiographics"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"223e225","DOI":"10.1016\/S0377-1237(07)80139-0","article-title":"Renal and perinephric abscesses revisited","volume":"63","author":"Rai","year":"2007","journal-title":"Med J Armed Forces India"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"86e89","DOI":"10.1111\/j.1464-410X.2011.10050.x","article-title":"Perinephric abscess","volume":"107","author":"Gardiner","year":"2011","journal-title":"BJU Int"},{"key":"ref7","first-page":"125","article-title":"Percutaneous kidney biopsy, analysis of 26 years: complication rate and risk factors; 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