Published: 2021-05-28

Large retroperitoneal hematoma in a patient with haemophilia B

Ramya Beedubailu, Prashant Tubachi


A spontaneous retroperitoneal hematoma is very rare and quite a challenging entity, more so when its presentation mimics other more common causes of acute abdomen, as in this interesting case. Here, patient presented with acute abdomen with polyarthralgia with flank ecchymosis (Grey Turner’s sign) with flank mass which lead us in the direction of acute pancreatitis. However, past history of recurrent bleeding episodes and positive family history along with blood investigations revealing an isolated prolongation of activated partial thromboplastin time tickled our brains with the differentials of coagulation disorders. Computed tomography showed large retroperitoneal hematoma. After initial resuscitation in the emergency room he was managed conservatively with fresh frozen plasma, cryoprecipitate and blood transfusions. On detailed evaluation, coagulation workup showed deficient coagulation factor IX levels leading us to the diagnosis of haemophilia B. Now, the patient is doing good on regular follow up.



Retroperitoneal hematoma, Spontaneous retroperitoneal hematoma, Acute pancreatitis, Bleeding disorders, Haemophilia B, Case report

Full Text:



Fisher WE, Andersen DK, Windsor JA, Saluja AK, Brunicardi FC. Pancreas. In: Schwartz’s Principles of Surgery. 10th ed. Ney York, NY: McGraw-Hill; 2010: 1351-1361.

Townsend C. In: Beauchamp DB, Evers M, Mattox K. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Elsevier; 2012: 1108-1110.

Philip J, Sarkar RS, Kumar S, Prathip BR, Pathak A. Factor IX deficiency (Christmas disease). Med J Armed Forces India. 2012;68(4):379-80.

Benson G, Auerswald G, Dolan G, Duffy A, Hermans C, Ljung R, et al. Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management. Blood Transfus. 2018;16(6):535-44.

Srivastava A, Brewer AK, Mauser BEP, Key NS, Kitchen S, Llinas A, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19(1):1-47.

Tolga MMA, Topaloglu U, Aktekin A, Odabasi M, Mehmet A, Abdullah S. The management of retroperitoneal hematomas. Scand J Trauma Resusc Emerg Med 2004;12;152-6.

Daly KP, Ho CP, Persson DL, Gay SB. Traumatic Retroperitoneal Injuries: Review of Multidetector CT Findings. Radiographics. 2008;28(6):1571-90.

Cabrera BD. Walking through the valley of death: Spontaneous Retroperitoneal Hematoma, 2021. Available at: Accessed on 20 March 2021.

Zil EAA, Chaudhri WM, Tariq R, Kumar V, Kumar AA. Management of a Retroperitoneal Hematoma in a Hemophilic Patient: A multi-disciplinary approach. Redelve Int. 2019;2019(2):5-8.

Daliakopoulos SI. Spontaneous retroperitoneal hematoma: A rare devastating clinical entity of a pleiada of less common origins. J Surg Tech Case Rep. 2011;3(1):8-9.

Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: Etiology, characteristics, management, and outcome. J Emerg Med. 2012;43(2):157-61.

Morfini M, Coppola A, Franchini M, Minno G. Clinical use of factor VIII and factor IX concentrates. Blood Transfus. 2013;11(4):55-63.