• Xi Chen, Zheng Li, Liangping Zou, Yupin Lan, Xiaoling Wu, and Hui Wang.
• Department of Gastroenterology, Zhangzhou Traditional Chinese Medicine Hospital, Zhangzhou, China.
• Medicine (Baltimore). 2025 Jan 10; 104 (2): e41077e41077.

RationaleSpontaneous retroperitoneal hematoma (SRH) is a rare but potentially fatal condition, often associated with anticoagulation therapy. With the global prevalence of COVID-19 and the widespread use of anticoagulants in its management, there is an increasing need to recognize rare but serious complications like SRH. This case report aims to emphasize the importance of early recognition and intervention of SRH in patients with COVID-19 undergoing anticoagulation therapy, to improve patient outcomes and reduce mortality.DiagnosesAn 86-year-old male with a history of COVID-19 presented with recurrent cough, hemoptysis, and fever. Initial treatment included antiviral and anticoagulant therapy. The patient later developed abdominal distension, pain, and eventually hypovolemic shock, leading to the diagnosis of SRH confirmed by imaging and a significant drop in hemoglobin levels.InterventionsThe patient received comprehensive supportive care, including noninvasive ventilation, antiviral therapy, and anticoagulants. Upon the onset of SRH, emergency interventions included fluid resuscitation, vasopressors, and interventional embolization of the bleeding vessels.OutcomesThe patient initially responded well to COVID-19 treatment but developed SRH, which was managed successfully with interventional embolization. Post-procedure, the patient's vital signs stabilized, hemoglobin levels gradually increased without the need for further transfusions, and he regained full consciousness. Over the following weeks, the patient showed continuous improvement, with resolution of abdominal pain and a return to baseline mobility. He was discharged in stable condition with scheduled follow-ups.LessonsThis case underscores the critical need for vigilance in monitoring patients on anticoagulation therapy, particularly those with COVID-19, for signs of SRH. Early recognition and prompt intervention are essential to improve outcomes. Clinicians should maintain a high index of suspicion for SRH in patients presenting with unexplained abdominal pain and hypovolemic shock, even in the absence of typical risk factors.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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