Retroperitoneal hematoma (RH) can appear as a result of various etiologies, including the chronic use of anticoagulants (warfarin, heparin, antiplatelet drugs), surgical procedures, rupture of aortic aneurysms, and blood dyscrasias, but by far, the most common cause is abdominal or pelvic trauma [1] [2] [3] [4] [5]. Hence, the terms spontaneous, traumatic, and idiopathic retroperitoneal hematomas are used in the literature [1] [2] [5]. Mortality rates for traumatic RH range from 6-60% according to different reports, suggesting that an early diagnosis is of critical importance [1] [2]. Unfortunately, this condition is missed up to 10% of patients [2]. The clinical presentation, however, might not always be indicative of a RH, with most common signs being abdominal pain and a sense of suprainguinal tenderness, but pain may sometimes appear in the leg, the hip, or radiate to the back [2] [3] [6]. Femoral numbness and neuropathy were identified in up to a third of cases [3] [6]. RH can also present as an abdominal mass accompanied by distension, whereas newly form ascites is a highly indicative sign of an ongoing process in the abdomen [1] [2] [3]. In severe cases, patients suffer from life-threatening hypotension and a severe hematocrit drop that is unresponsive to standard therapy [6].

• Massive Splenomegaly

  General physical examination revealed pallor, sternal tenderness and massive splenomegaly. [pubs.sciepub.com]

• Falling

  We report a case of a right retroperitoneal haematoma detected on Tc-99m-methylene diphosphonate bone scintigraphy taken in an elderly patient presenting with a mechanical fall and a right acetabular fracture. [ncbi.nlm.nih.gov]

  Falls can cause hematomas in the legs, chest, or brain, and may, at times, result in significant illness or death. Therefore, measures to prevent falls in this population potentially lower the frequency of hematomas as well. [rxlist.com]

  Delayed presentation of shock due to retroperitoneal hemorrhage following a fall. [onlinejets.org]

  It can be traumatic or non-traumatic (spontaneous) with signs and symptoms of flank or abdominal pain, hematuria and shock.[1][2] Most common cases occur in traumas with automobile accidents and falls leading the causes, with less common non traumatic [en.wikipedia.org]

• Fever

  On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. [ncbi.nlm.nih.gov]

  Robotic Surgery, social media, STAMPEDE trial, SUSPEND trial, tamsulosin, The Urology Foundation, Twitter, Ureteric stones, urological oncology We present the case of a middle age male with ESRD with post transplant graft rejection, who presented with fever [bjuinternational.com]

  Psoas hematomas can present with constipation, urinary frequency, or fever if they are large. They can even compress the femoral nerve and cause a femoral neuropathy 3,4. [radiopaedia.org]

  […] abdominal compartment syndrome (e.g. intra-abdominal hypertension, renal failure) history of risk factors (often no significant history if spontaneous) Psoas haematoma can present with constipation, urinary frequency, compressive femoral neuropathy or fever [lifeinthefastlane.com]

• Inguinal Pain

  The common symptom in all patients with a hematoma was inguinal pain. The mean hematoma volume was 527.9 ml (range 53.3-1274.1 ml). [ncbi.nlm.nih.gov]

• Dyspnea

  Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. [ncbi.nlm.nih.gov]

  Case illustration We recently had an elderly man with aortic stenosis and dyspnea on minimal exertion. Femoral access was selected over radial because we wanted to get an optimal and quick hemodynamic study for his aortic stenosis. [cathlabdigest.com]

• Abdominal Pain

  A case of acute right lower quadrant abdominal pain five days following thrombolytic therapy and percutaneous transluminal coronary angioplasty is presented. [ncbi.nlm.nih.gov]

• Nausea

  The patient did not complain of nausea or vomiting and was discharged after 43 days. Although massive retroperitoneal hematoma is a minor complication after colonoscopy, it can be life threatening; thus, we need to know more about this complication. [ncbi.nlm.nih.gov]

  […] these most common side effects persist or become bothersome: Blurred vision or vision problems (spots or flashes); breast tenderness; dizziness; enlarged breasts; enlargement of the ovaries; flushing; headache; hot flashes; lightheadedness; mood change; nausea [canadian-pharmacy-cheap.com]

  She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting. Review of systems is positive for abdominal discomfort and constipation for 2 days. [emdocs.net]

  Sudden onset of flank pain, nausea, and hypotension was revealed. The treatment in asymptomatic angiomyolipoma is conservative treatment and intermittant follow up examination [1,7,8]. [thecystoscope.com]

  Symptoms include abdominal pain, gastrointestinal bleeding, diarrhea (68%), abdominal distention (63%) and nausea/vomiting (38%) [ 5 ]. [academic.oup.com]

• Vomiting

  The patient did not complain of nausea or vomiting and was discharged after 43 days. Although massive retroperitoneal hematoma is a minor complication after colonoscopy, it can be life threatening; thus, we need to know more about this complication. [ncbi.nlm.nih.gov]

  Case Report A 35-year-old woman was admitted to emergency service because of left flank pain, nause and vomiting. [thecystoscope.com]

  […] bothersome: Blurred vision or vision problems (spots or flashes); breast tenderness; dizziness; enlarged breasts; enlargement of the ovaries; flushing; headache; hot flashes; lightheadedness; mood change; nausea; pelvic pain or bloating; stomach pain; vomiting [canadian-pharmacy-cheap.com]

  She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting. Review of systems is positive for abdominal discomfort and constipation for 2 days. [emdocs.net]

  Symptoms include abdominal pain, gastrointestinal bleeding, diarrhea (68%), abdominal distention (63%) and nausea/vomiting (38%) [ 5 ]. [academic.oup.com]

• Cullen's Sign

  Eponymictionary – Cullen sign Journal articles Chan YC, Morales JP, Reidy JF, Taylor PR. [lifeinthefastlane.com]

  ’s sign (periumbilical ecchymosis) – late finding Grey-Turner’s sign (ecchymosis of the flanks) – late finding *History of risk factors as above Evaluation and Diagnosis 1,3,4,5 Complete Blood Count for anemia Lipase – suggests pancreatic or duodenal [emdocs.net]

• Severe Abdominal Pain

  Twenty-one hours after admission, the patient’s condition worsened and she was complaining of severe abdominal pain. C-reactive protein increased to 123 mmol/l. [academic.oup.com]

  However, the presentation in a middle-aged female with sudden onset hypotension with anemia with severe abdominal pain (left iliac and lumbar region) following defecation (increased abdominal pressure) with a preexisting thrombus in the left iliac vein [jscisociety.com]

• Tachycardia

  Non-specific symptoms such tachycardia, hypotension, and anaemia are the most prevalent in this complication. With this case, our aim is to describe serious complications related to XLIF. [ncbi.nlm.nih.gov]

  Signs The patient may develop tachycardia and hypotension if the rate of hemorrhage is rapid. Rarely, later in the course, the patient may develop a Grey-Turner’s sign with bulging flanks, and a bluish discoloration in the region of the flank. [medicalopedia.org]

• Chest Pain

  A case of fatal retroperitoneal hematoma that developed after enoxaparin administration in a woman with paroxysmal atrial flutter and chest pain is reported. [ncbi.nlm.nih.gov]

  She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting. Review of systems is positive for abdominal discomfort and constipation for 2 days. [emdocs.net]

  The patient presented to the outside facility complaining of cough, pleuritic chest pain and shortness of breath for three weeks. His vital signs were normal except for a heart rate of 150 beats per minute. [ijcasereportsandimages.com]

  There was no personal or family history of coagulopathy or stroke, valvular heart disease trauma, chest pain or illicit intravenous drug usage. He smoked 20 cigarettes daily and consumed alcohol in moderation in the past. [jmedicalcasereports.biomedcentral.com]

• Palpitations

  She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting. Review of systems is positive for abdominal discomfort and constipation for 2 days. [emdocs.net]

• Fracture

  avulsion, rupture Pelvic fracture Loss of blood from site of fracture Disruption of pelvic venous plexus History and Physical Exam Findings 1,2,6 Lenk or Wunderlich Triad Pain: Back, groin, flank, abdomen (most common presenting symptom) Palpable mass [emdocs.net]

  We report a case of a right retroperitoneal haematoma detected on Tc-99m-methylene diphosphonate bone scintigraphy taken in an elderly patient presenting with a mechanical fall and a right acetabular fracture. [ncbi.nlm.nih.gov]

  We report a rare case of ischemic proctosigmoiditis caused by a retroperitoneal hematoma due to a pelvic fracture. [academic.oup.com]

• Back Pain

  The patient, a 78-year-old man who had undergone antiplatelet treatment using ticlopidine, was admitted to our hospital with complaints of sudden-onset low abdominal and back pain. [ncbi.nlm.nih.gov]

• Hip Pain

  Clinical Case A 74 year-old woman with a past medical history of coronary artery disease, aortic stenosis with mechanical valve replacement, and diabetes, presents with right wrist and hip pain after a mechanical trip and fall at home. [emdocs.net]

  Patients report lower abdominal or hip pain radiating to the groin or anterior thigh. Bleeding into the psoas muscle causes spasm and hip flexion and, as it extends, flank or thigh bruising may appear. [bjmp.org]

• Grey Turner's Sign

  Turner sign Eponymictionary – Cullen sign Journal articles Chan YC, Morales JP, Reidy JF, Taylor PR. [lifeinthefastlane.com]

  Signs The patient may develop tachycardia and hypotension if the rate of hemorrhage is rapid. Rarely, later in the course, the patient may develop a Grey-Turner’s sign with bulging flanks, and a bluish discoloration in the region of the flank. [medicalopedia.org]

  Her physical examination disclosed left abdominal and costovertebral angle tenderness, left flank ecchymosis (Grey Turner sign). Abdominal computerised tomography revealed spontaneous retroperitoneal haemorrhage. [ncbi.nlm.nih.gov]

  It can present with Grey Turner's sign (flank bruising). [en.wikipedia.org]

  (periumbilical ecchymosis) – late finding Grey-Turner’s sign (ecchymosis of the flanks) – late finding *History of risk factors as above Evaluation and Diagnosis 1,3,4,5 Complete Blood Count for anemia Lipase – suggests pancreatic or duodenal injury [emdocs.net]

• Flank Pain

  The patient presented to the emergency room with significant right flank pain, and computed tomography (CT) demonstrated a large, right-sided retroperitoneal hematoma with no identifiable etiology. [ncbi.nlm.nih.gov]

  Case Report A 35-year-old woman was admitted to emergency service because of left flank pain, nause and vomiting. [thecystoscope.com]

  Symptoms The patient may complain of intense flank pain or back pain. Signs The patient may develop tachycardia and hypotension if the rate of hemorrhage is rapid. [medicalopedia.org]

• Dizziness

  Check with your doctor if any of these most common side effects persist or become bothersome: Blurred vision or vision problems (spots or flashes); breast tenderness; dizziness; enlarged breasts; enlargement of the ovaries; flushing; headache; hot flashes [canadian-pharmacy-cheap.com]

  Prior to admission, the patient had fallen at home and was complaining about dizziness, lower abdominal pain, watery stool for the past 24 h and right-sided pelvic pain. [academic.oup.com]

  Case report A 51-year-old woman with no significant medical history presented to her local hospital with a history of the fall at home in the bathroom following sudden onset dizziness and loss of consciousness. [jscisociety.com]

  On the day of admission, examination of the patient revealed intense dizziness with diplopia, instability and complete left-sided homonymous hemianopsia. [jmedicalcasereports.biomedcentral.com]

  The pain was associated with sweating, dizziness, pallor, and dyspnoea. He has no history of trauma, drug use, or other chronic diseases. Finally, this patient was referred to our department by the orthopedist. [omicsonline.org]

• Headache

  Check with your doctor if any of these most common side effects persist or become bothersome: Blurred vision or vision problems (spots or flashes); breast tenderness; dizziness; enlarged breasts; enlargement of the ovaries; flushing; headache; hot flashes [canadian-pharmacy-cheap.com]

  She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting. Review of systems is positive for abdominal discomfort and constipation for 2 days. [emdocs.net]

  For example, a subdural hematoma resulting in symptoms such as headache, weakness, or confusion may require urgent drainage by a neurosurgeon. [rxlist.com]

• Paresis

  Three months later, he had only marginal paresis of the right quadriceps muscle and thigh adductors. [nejm.org]

  […] rupture Pelvic fracture Loss of blood from site of fracture Disruption of pelvic venous plexus History and Physical Exam Findings 1,2,6 Lenk or Wunderlich Triad Pain: Back, groin, flank, abdomen (most common presenting symptom) Palpable mass Shock Leg paresis [emdocs.net]

  Three months later he had signs of partial lateral paresis of the right quadriceps muscle and thigh adductors and, at 1-year follow-up, the only findings were suggestive of the previous transient ischemic attack involving the carotid artery territory; [jmedicalcasereports.biomedcentral.com]

• Femoral Nerve Compression

  Locally the haematoma may cause ureteric obstruction and acute renal failure, or femoral nerve compression. 11 (Both of which were seen in the case reported). [bjmp.org]

  A retroperitoneal haematoma resulting in a femoral nerve root compression was suspected. [emj.bmj.com]

• Giddiness

  Case Report A 35 year old male presented to the causality department with history of vague abdominal discomfort and giddiness. On examination the patient had pulse rate of 130 per minute and blood pressure of 90/60 mm of Hg. [pubs.sciepub.com]

The diagnosis can be missed because of the nonspecific presentation of retroperitoneal hematoma [2], which is why a thorough examination of patients who suffered from recent abdominal or pelvic trauma, or who are receiving anticoagulant therapy, must be carried out when the previously mentioned complaints are noticed. For this reason, a detailed patient history that confirms the use of medications or recent trauma may be the crucial step in making a presumptive diagnosis. After a comprehensive physical examination, imaging studies need to be employed. Abdominal ultrasonography, although being a fast and convenient first-line study, has a very low detection rate of retroperitoneal hematomas, making CT scan the gold-standard for identifying this clinical entity [7]. Acute and subacute hematomas (being present for < 7 days or between 7 days and 7 weeks, respectively) have a high-attenuating heterogeneous appearance on CT, whereas chronic hematomas (lasting > 7 weeks), exhibit a low-attenuating pattern due to degradation of red blood cells and subsequent accumulation of hemosiderin [4] [5]. Some reports have observed the striking similarities of RH with malignant tumors (eg. sarcomas), but the typical findings of hematomas - a sharply defined margin and progressive reduction in size are used to discriminate between these lesions [4] [8] [9]. MRI requires more preparation and time that may not always be feasible, but its superiority compared to CT by revealing a hyperintense mass on both T1 and T2-weighted images is well-documented [4] [9].

Retroperitoneal hematomas are often fatal, and treatment involves aggressive fluid resuscitation with possible surgical decompression. [ncbi.nlm.nih.gov]

The diagnosis and treatment of traumatic retroperitoneal hematoma. [pjms.com.pk]

Retroperitoneal hematoma treatment The treatment for this type of hematoma include invasive operation procedures as well as a particular type of nonsurgical treatment called angiographic embolization, where access to the bleeding artery is provided to [thrombocyte.com]

Therapy and prognosis will be also discussed. [ncbi.nlm.nih.gov]

It has a better prognosis compared to that of the acute type. Surgery Inappropriate surgical evacuation can exacerbate hemorrhage by relieving hematoma induced tamponade. [radiopaedia.org]

The patient presented to the emergency room with significant right flank pain, and computed tomography (CT) demonstrated a large, right-sided retroperitoneal hematoma with no identifiable etiology. [ncbi.nlm.nih.gov]

Through literature revision, we have discussed the etiological aspects of this disease and the importance of obtaining the preoperative diagnosis for an appropriate and conservative operative treatment. [scielo.br]

Howalt and Squires [7] have advised conservative management in case diagnostic studies fail to demonstrate significant etiology. Conservative approach has also been supported by Swift and associates [8] if no etiology is found. [indianjurol.com]

Systematic review: the epidemiology of ischaemic colitis. Aliment Pharmacol Ther 2004 ; 19 : 729 – 38. 7. Assessment of potential risk factors associated with ischaemic colitis. [academic.oup.com]

Epidemiology of renal trauma: In blunt abdominal trauma, up to 40% present with renal injury. In urban areas, 80% of renal injuries occur in the context of polytrauma. In ski resorts, 2/3 of renal injuries are due to skiing accidents. [urology-textbook.com]

Wight J, Paisley S (2003) The epidemiology of inhibitors in haemophilia A: a systematic review. Haemophilia 9: 418-435. White GC 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, et al. (2001) Definitions in hemophilia. [omicsonline.org]

The pathophysiological mechanisms underlying development and treatment of these aneurysms are discussed. [ncbi.nlm.nih.gov]

On the pathophysiology of intestinal ischemic injury. Clinical review. Acta Chir Scand 1987 ; 153 : 321 – 4. 4. Ischemic proctosigmoiditis. Am J Gastroenterol 1996 ; 91 : 2305 – 9. 5. Ischemic colitis: clinical practice in diagnosis and treatment. [academic.oup.com]

A plethora of conditions have been used as a possible hypothesis of the pathophysiology of SRH. Unrecognized minor trauma in the microcirculation in the presence of coagulopathy has been suggested [ 13, 14 ]. [jmedicalcasereports.biomedcentral.com]

The pathophysiology of the spontaneous RPHs is unclear. [omicsonline.org]

Our review shows that even if many works suggest that fondaparinux is a safe and effective alternative to LMWH in the prevention of venous thromboembolism following major orthopaedic surgery, it should carefully be used in elderly people and patients [ncbi.nlm.nih.gov]

1. Wang F, Wang F. The diagnosis and treatment of traumatic retroperitoneal hematoma. Pak J Med Sci. 2013;29(2):573-576.
2. Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med. 2012;43(2):e157-161.
3. Murai Y, Adachi K, Yoshida Y, Takei M, Teramoto A. Retroperitoneal hematoma as a serious complication of endovascular aneurysmal coiling. J Korean Neurosurg Soc. 2010;48(1):88–90.
4. Rajiah P, Sinha R, Cuevas C, Dubinsky TJ, Bush WH Jr, Kolokythas O. Imaging of uncommon retroperitoneal masses. Radiographics. 2011;31(4):949-976.
5. Abe T, Kai M, Miyoshi O, Nagaie T. Idiopathic Retroperitoneal Hematoma. Case Rep Gastroenterol. 2010;4(3):318-322.
6. Kent KC, Moscucci M, Mansour KA, et al. Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management. J Vasc Surg. 1994;20:905–910.
7. Kawashima A, Sandler CM, Ernst RD, et al. Imaging of nontraumatic hemorrhage of the adrenal gland. Radiographics. 1999;19(4):949-963.
8. Surabhi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple NC. Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. Radiographics. 2008;28(4):1005-1017.
9. Yang DH, Goo HW. Generalized lymphangiomatosis: radiologic findings in three pediatric patients. Korean J Radiol. 2006;7(4):287-291.