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Retroperitoneal hematoma

Last updated: July 22, 2025

Summarytoggle arrow icon

Retroperitoneal hematoma (RPH) is bleeding into the retroperitoneal space, which may occur spontaneously (most often in patients on anticoagulants), after blunt or penetrating trauma, or iatrogenically following procedures such as percutaneous coronary intervention. Patients may be asymptomatic or present with flank, back, abdominal, and/or leg pain. Significant bleeding can lead to hemodynamic instability. CT abdomen and pelvis with IV contrast is the diagnostic modality of choice and may demonstrate contrast extravasation if there is ongoing bleeding. Most spontaneous and iatrogenic RPHs can be managed conservatively with close observation, transfusions, and correction of coagulopathies (e.g., anticoagulant reversal). Angiographic embolization or surgery may be necessary if bleeding persists despite conservative treatment. Complications include hemorrhagic shock and abdominal compartment syndrome.

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Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

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Etiologytoggle arrow icon

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Clinical featurestoggle arrow icon

Clinical features vary based on hematoma size, bleeding rate, and mass effect on nearby organs. Patients may be asymptomatic or present with nonspecific symptoms. [6][8]

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Diagnosistoggle arrow icon

For suspected traumatic RPH, see also “Urgent diagnostics for trauma patients.”

Approach

Imaging [11]

  • CT abdomen and pelvis with IV contrast (recommended) [5][6]
    • To determine size and location of hematoma
    • To evaluate for recent and/or active bleeding
  • MRI abdomen and pelvis [6]
    • Comparable diagnostic accuracy to CT
    • Limited by availability and study duration
  • Ultrasound abdomen and pelvis (not recommended) [11]
    • Cannot evaluate the entire retroperitoneum
    • Cannot detect active bleeding
    • May miss small RPHs

FAST has limited sensitivity for RPH and should not be used in isolation when RPH is suspected. [12]

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Managementtoggle arrow icon

Management depends on etiology and hemodynamic stability of the patient, with guidance largely based on expert consensus. A multidisciplinary approach (e.g., surgery, interventional radiology) is often required.

Approach [2][6][13]

Conservative management [2][13][14]

Surgical and interventional management [2][6][13]

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Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

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