Abstract
A retrospective single center review was performed at the Massachusetts General Hospital between 2012 and 2017. Of 100 patients with spontaneous retroperitoneal (70%) and rectus sheath hematomas (27%) or both (3%) identified on computed tomography (CT) scan, 82% were receiving therapeutic anticoagulation and 90% had serious comorbidities. Although overall mortality was 22%, spontaneous retroperitoneal and rectus sheath hematoma-related mortality was 6%. Flank pain and active intravenous contrast material extravasation on CT scan were independent predictors of intervention, which was required in only 16% of patients: endovascular intervention, 10 (lumbar, inferior epigastric, renal, iliac, iliolumbar artery); surgery, 5; both, 1. Age >70 years and systolic blood pressure <110 mm Hg were independent predictors of mortality. Spontaneous retroperitoneal and rectus sheath hematomas have high mortality but are usually not the direct cause of death. Most of these hematomas do not require intervention.
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