Spontaneous Retroperitoneal Hematoma: a Case Report, Review of Literature, and Proposal of Diagnostic and Management Algorithm

Abstract

\n Background: Spontaneous retroperitoneal hematoma (SRH) is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm. Case presentation: A 48-year-old man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin (Hb) was diagnosed with SRH. Contrast-enhanced computed tomography (CT) revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the 10th hospital day without any morbidity. Conclusions: SRH treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of SRH is so high that the optimal treatment timing needs to be carefully judged based on detailed evaluation and management algorithm with clear criteria.