The clinical presentation of retroperitoneal hematoma is often nonspecific. Mild cases may show only vague discomfort, while severe cases can quickly progress to hemorrhagic shock. Main manifestations include:
- Abdominal pain – the most frequent symptom, usually steady and dull, located in the upper, lower or flank abdomen and sometimes radiating to the back .
- Low-back pain – caused by direct compression or irritation of lumbar muscles and nerves .
- Abdominal distension & decreased bowel sounds – due to paralytic ileus secondary to hematoma compression or irritation .
- Hypovolemia & shock – the retroperitoneal space can conceal >2 L of blood; patients may suddenly develop pallor, tachycardia, hypotension and even collapse .
- Nerve compression – femoral neuropathy with anterior thigh pain, numbness or weakness when the hematoma extends into the iliac fossa .
- Urinary symptoms – hematuria, dysuria or acute urinary retention if the kidneys, ureters or bladder are involved .
- Peritoneal irritation signs – muscular guarding, rebound tenderness and absent bowel sounds when the hematoma is large or ruptures into the peritoneal cavity .
- Late complications – infection, multiple organ dysfunction or re-bleeding may appear if the hematoma is not promptly managed .
Because of this variability, any patient with lumbar-abdominal trauma, pelvic/spinal fracture, persistent abdominal-flank pain, unexplained shock or paralytic ileus should be evaluated for retroperitoneal hematoma, preferably by emergency CT.
| Aspect | Key Points |
|---|---|
| Most common symptom | Abdominal pain (46–68 %) |
| Typical location | Flank, lower abdomen, back |
| Alarm signs | Tachycardia, hypotension, pale skin, oliguria |
| Neurological sign | Femoral nerve palsy (thigh pain/weakness) |
| Imaging of choice | Contrast-enhanced CT |
| Major risk | Occult hemorrhagic shock, mortality 35–42 % |