Spontaneous retroperitoneal hemorrhage (SRH) is a distinctive clinical pathology of retroperitoneal bleeding without a preceding history of trauma.
For a broader discussion, including other etiologies, please refer to the parental article on retroperitoneal hemorrhage.
Clinical presentation may be vague and varied:
- no inciting history
- no evidence of cutaneous bruising
- back, lower abdominal or groin pain
- hemodynamic instability
- fall in hemoglobin
The pathophysiology and pathogenesis of spontaneous retroperitoneal bleeding are unclear. Many hypotheses have been put forth:
- diffuse vasculopathy and arteriosclerosis of small retroperitoneal vessels renders them friable and prone to rupture 1
- anticoagulation induced immune microangiopathy may cause an unrecognised minor trauma in the microcirculation to cause a hemorrhage 2
Spontaneous retroperitoneal hemorrhage is uncommon and is almost exclusively seen in association with:
- rupture of aortic or visceral artery aneurysm
- rupture of a pathological lesion in a retroperitoneal organ (renal and adrenal)
- anticoagulation states
Treatment and prognosis
Based on the clinical scenario and cause, the management can be endovascular repair or open surgery.
- 1. Davies GA, Lazo-Langner A, Shkrum M et-al. Spontaneous retroperitoneal hemorrhage in a patient with prolymphocytic transformation of chronic lymphocytic leukemia. Case Rep Hematol. 2013;2013: 802376. doi:10.1155/2013/802376 - Free text at pubmed - Pubmed citation
- 2. McCort JJ. Intraperitoneal and retroperitoneal hemorrhage. Radiol. Clin. North Am. 1977;14 (3): 391-405. Pubmed citation
- 3. Jarral OA, Todd C, Willson PD. Hemorrhagic shock secondary to spontaneous rupture of a non-secretory adrenal cortical tumour: A case report. Can Urol Assoc J. 2011;4 (6): E161-3. Free text at pubmed - Pubmed citation
- 4. Sunga KL, Bellolio MF, Gilmore RM et-al. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med. 2012;43 (2): e157-61. doi:10.1016/j.jemermed.2011.06.006 - Pubmed citation