Spontaneous retroperitoneal hemorrhage

Last revised by Craig Hacking on 29 Apr 2024

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:

Based on the clinical scenario and cause, the management can be endovascular repair or open surgery.

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