Spontaneous Retroperitoneal Hematoma: A Case Report

Spontaneous retroperitoneal hematoma is a rare condition caused by extravasations of blood into the retroperitoneal space with no history of external trauma or previous vascular procedures. Its clinical presentation can be insidious, evolving for a few days, or sudden, depending on the amount of bleeding. The classic triad of presentation, called Lenk's triad, characterized by abdominal pain, palpable mass and hypovolemic shock. Diagnosis is made by imaging studies such as computed tomography (CT) or ultrasound. Treatment can be surgical or conservative depending on the hemodynamic status of the patient. In the case, the patient presented a sudden low back pain on the left, with a slow decrease in hematocrit, however, no signs of significant hemodynamic changes during hospitalization and the diagnosis was demonstrated by means of abdominal CT that showed the presence massive retroperitoneal hematoma left encompassing the left adrenal and perirenal fascia. There was no report of previous external trauma, but the patient had a regular use of acetylsalicylic acid (ASA) 100 mg daily. The CT scan did not show any other changes that could have caused the bleeding. The treatment was conservative, and the patient was discharged after 11 days of hospitalization. The diagnosis was spontaneous retroperitoneal hematoma due to spontaneous arterial injury by minimal effort or aggravated by the use of ASA.