Retroperitoneal hemorrhage


Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.
Renal anatomy.
  • Bleeding into retroperitoneal space
  • Difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners)
  • Can accumulate 4L blood before tamponade


  • Trauma (renal, vascular, colon, pancreas or pelvis)
  • Leaking/ruptured AAA
  • Iatrogenic (colonoscopy, cardiac catheterization, femoral line placement)
  • Spontaneous (coagulopathy)
  • Hemorrhagic pancreatitis

Clinical Features

Differential Diagnosis

Abdominal Trauma



Right kidney contusion (open arrow) and blood surrounding the kidney (closed arrow).
Left kidney injury (open arrow) with retropeitoneal hematoma (closed arrow).

Must have high clinical suspicion to make diagnosis

  • CT scan abdomen/pelvis
  • Consider ultrasound for AAA
  • FAST and DPL do not evaluate retroperitoneal space

Classification of traumatic retroperitoneal hemorrhage[3]

Retroperitoneal zones
  • Zone 1: Central
    • Pancreaticoduodenal injuries, major vascular injury
  • Zone 2: Flank/Perinephric
  • Zone 3: Pelvic
    • Pelvic fracture or ileofemoral vascular injury



  • ICU

See Also

External Links


  1. Bhasin HK and Dana CL. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron. 1978; 22(4-6):322-327.
  2. Ernits M, et al. A retroperitoneal bleed induced by enoxaparin therapy. Ann Surg. 2005; 71(5):430-433.
  3. FELICIANO, D. V. (1990) ‘Management of Traumatic Retroperitoneal Hematoma’, Annals of Surgery, 211(2), pp. 109–123.