# Spontaneous Retroperitoneal Hematoma in SARS-CoV-2 Patients: Diagnostic and Management Challenges—A Literature Review

## TL;DR

This paper reviews the challenges in diagnosing and managing rare retroperitoneal hematomas in SARS-CoV-2 patients, emphasizing the need for early detection and multidisciplinary care.

## Contribution

The paper synthesizes current diagnostic and therapeutic approaches for a rare but increasing complication in COVID-19 patients.

## Key findings

- Most cases occur in anticoagulated patients with nonspecific symptoms like abdominal or lumbar pain.
- Contrast-enhanced CT is the primary diagnostic tool, while treatment includes conservative, endovascular, or surgical methods.
- Outcomes vary from recovery to death, especially in elderly and comorbid individuals.

## Abstract

Background: Spontaneous retroperitoneal hematomas constitute a rare clinical entity, yet their incidence has markedly increased during the SARS-CoV-2 pandemic. The pathophysiological substrate is incompletely elucidated, being influenced by anticoagulant therapy, vascular inflammatory alterations induced by SARS-CoV-2 infection, and comorbidities in critically ill patients that exacerbate hemorrhagic risk. Methods: We performed a comprehensive literature review of published case reports and case series on spontaneous retroperitoneal hematomas in COVID-19 patients, complemented by our institutional experience, in order to synthesize current diagnostic and therapeutic approaches. Results: Available evidence indicates that most cases occur in anticoagulated patients, with clinical manifestations often limited to nonspecific abdominal or lumbar pain. Diagnosis relies primarily on contrast-enhanced CT imaging. Reported therapeutic strategies include conservative management, endovascular embolization, and surgical intervention, with outcomes ranging from complete recovery to fatal progression, particularly in elderly and comorbid individuals. Conclusions: Spontaneous retroperitoneal hematomas in the setting of SARS-CoV-2 infection represent a diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Early recognition, prompt imaging, and individualized multidisciplinary management are essential, while further research is needed to clarify incidence, risk factors, and preventive strategies.