| Summary: | Myelolipoma is a benign tumor of the adrenal cortex, which is non-functioning and often asymptomatic. It is generally diagnosed in imaging tests by chance. Rupture and bleeding of myelolipoma is an infrequent complication, and may lead to the formation of a hematoma or, less usually, result in a massive retroperitoneal hemorrhage. The compression of adjacent structures by retroperitoneal hematoma of adrenal origin is possible but not frequent. Indications for surgery continue to be a difficult and controversial decision, since a conservative treatment and a watchful waiting may be indicated in some cases. However, the surgical procedure has been more precisely indicated to symptomatic patients (pain or infection) or even to uncertain diagnosis (malignant neoplasm). The authors present a case of a giant myelolipoma of the adrenal gland that presented both complicated spontaneous rupture (abdominal pain) and uncertain diagnosis by radiological images (computed tomography). The patient underwent a surgical resection with favorable postoperative outcome and pain relief.
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