Retroperitoneal Hematoma
A collection of blood behind the abdominal cavity
Quick Facts
- Type: Internal bleeding
- Common causes: Pelvic trauma, vessel rupture, blood thinners
- Main signs: Back/flank pain, signs of blood loss
- Risk: Hidden bleeding and shock
Overview
The retroperitoneum is the space at the back of the abdomen, behind the lining that holds the intestines. It contains the kidneys, parts of major blood vessels, and other structures. A retroperitoneal hematoma is a collection of blood that gathers in this space. Because the area can hold a large amount of blood and is hidden from view, bleeding here may not be obvious from the outside.
Retroperitoneal hematomas can result from trauma, a ruptured blood vessel such as an aortic aneurysm, complications of procedures, or a tendency to bleed, including from blood-thinning medication. Depending on the cause and the amount of bleeding, they range from minor to life-threatening.
Symptoms
Symptoms depend on how much bleeding occurs and how quickly. They may include:
- Pain in the back, flank, or abdomen
- A feeling of fullness or a mass in the abdomen
- Pain that spreads to the groin or thigh
- Dizziness, weakness, pale skin, and sweating
- Rapid heartbeat and low blood pressure with significant blood loss
- Bruising on the flanks or around the navel in some cases
Severe back or abdominal pain with signs of shock, such as dizziness, fainting, or a racing heartbeat, is an emergency. Because the bleeding is hidden, blood loss can be greater than it appears.
Causes
A retroperitoneal hematoma can form from several causes, including:
- Trauma: Pelvic fractures, kidney injury, or other damage from crashes and falls is a leading cause.
- Ruptured blood vessel: A leaking or burst aortic or iliac aneurysm.
- Bleeding tendency: Blood-thinning medications or bleeding disorders can cause spontaneous bleeding.
- Procedures: Catheter-based procedures through the groin can occasionally cause bleeding into this space.
- Tumors: Rarely, a bleeding tumor in the area.
The cause strongly influences how serious the hematoma is and how urgently it must be treated.
Risk Factors
- Major trauma, especially pelvic fractures and kidney injury
- Blood-thinning medication
- Bleeding disorders
- Aortic or iliac aneurysm
- Recent catheter-based procedures through the groin
- Older age and fragile blood vessels
Diagnosis
Doctors diagnose a retroperitoneal hematoma using imaging and blood tests:
- CT scan: The main test, showing the blood collection, its size, and often the source of bleeding.
- CT angiography: Highlights active bleeding from a vessel.
- Blood tests: To check for falling blood counts and assess clotting.
- Ultrasound: May be used at the bedside, especially after trauma.
Identifying whether the bleeding is ongoing and where it comes from guides whether observation or active treatment is needed.
Treatment
Treatment depends on the cause, size, and whether bleeding is ongoing.
- Supportive care: Many stable, small hematomas are managed with rest, monitoring, and treating the underlying cause.
- Reversing blood thinners: If a blood thinner contributed, its effect may be reduced or reversed.
- Transfusion and resuscitation: Fluids and blood for significant blood loss.
- Embolization: Through a catheter, doctors can block a bleeding vessel.
- Surgery: Used for ongoing bleeding that cannot be controlled, or to repair a ruptured aneurysm or injured organ.
Stable hematomas often resolve as the body reabsorbs the blood over weeks, while active bleeding needs prompt treatment.
Prevention
- Take blood-thinning medication exactly as prescribed and attend monitoring
- Wear seatbelts and protective equipment to reduce trauma
- Get recommended screening and care for aortic aneurysms if at risk
- Report unusual bruising or back pain if you are on blood thinners
When to See a Doctor
Seek emergency care for sudden, severe back, flank, or abdominal pain, especially with:
- Dizziness, fainting, or weakness
- Pale, sweaty skin and a racing heartbeat
- Bruising on the flanks or around the navel
- A known aneurysm, recent procedure, or use of blood thinners
Because retroperitoneal bleeding is hidden, the amount lost can be dangerous even without external signs. Call emergency services right away if you have severe pain with any signs of shock.
Frequently Asked Questions
What is a retroperitoneal hematoma?
It is a collection of blood in the retroperitoneum, the space behind the abdominal cavity that holds the kidneys and major blood vessels. Because this space is hidden, bleeding there may not be obvious from the outside.
What causes bleeding behind the abdomen?
Common causes include trauma such as pelvic fractures and kidney injury, a ruptured aortic or iliac aneurysm, blood-thinning medication or bleeding disorders, and complications of catheter-based procedures through the groin.
How is a retroperitoneal hematoma treated?
Small, stable hematomas are often watched while the underlying cause is treated. Significant bleeding may need transfusions, reversal of blood thinners, blocking the bleeding vessel through a catheter, or surgery.
When is a retroperitoneal hematoma an emergency?
Severe back, flank, or abdominal pain with signs of shock, such as dizziness, fainting, pale sweaty skin, and a racing heartbeat, is an emergency. This is especially urgent with a known aneurysm or while taking blood thinners.
Can a retroperitoneal hematoma go away on its own?
Many small, stable hematomas resolve over weeks as the body reabsorbs the blood, with monitoring and treatment of the cause. Ongoing or heavy bleeding, however, needs prompt active treatment.
References
- American College of Surgeons. Abdominal and Pelvic Trauma.
- Society for Vascular Surgery. Aneurysm and Vascular Bleeding.
- MedlinePlus, U.S. National Library of Medicine. Internal bleeding.
- National Heart, Lung, and Blood Institute (NHLBI). Bleeding and shock.