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.
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Clinical presentation
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
Pathology
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
Etiology
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
- coagulopathies
- hemodialysis
Treatment and prognosis
Based on the clinical scenario and cause, the management can be endovascular repair or open surgery.
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