Spontaneous retroperitoneal haematoma causing acute haemodynamic collapse: a case report

Spontaneous retroperitoneal haemorrhage is a rare but potentially life-threatening cause of acute abdominal pain and shock. We report a 70-year-old man with polycythaemia on aspirin who presented with sudden right-sided abdominal pain, groin discomfort, leg paraesthesia and haemodynamic instability. Computed tomography (CT) demonstrated a large right-sided retroperitoneal haematoma with active arterial extravasation, confirmed on CT angiography. Management was complicated by the patient's refusal of blood transfusion despite counselling. Although endovascular embolisation was planned, his clinical deterioration coincided with interventional radiology being unavailable due to another emergency. He progressed to refractory shock and died 21 hours after presentation. This case highlights the need for early CT imaging, timely access to embolization and sensitive communication when patient beliefs limit treatment options in acute haemorrhagic emergencies.