Spontaneous Perigastric Hematoma and Hemoperitoneum Associated With Rivaroxaban Therapy: A Case Report and Review of the Literature.
- 1Emergency Medicine, Mohammed V Military Teaching Hospital, Rabat, MAR.
Abstract
Spontaneous hemoperitoneum is a rare but potentially life-threatening complication of direct oral anticoagulant (DOAC) therapy. We report the case of a 59-year-old man receiving long-term rivaroxaban for atrial flutter, previously treated with tricuspid isthmus ablation, who was admitted for atypical chest pain and subsequently developed acute abdominal pain during observation. Contrast-enhanced computed tomography (CT) revealed spontaneous intra-abdominal hemorrhage presenting as a perigastric hematoma with hemoperitoneum, with the perigastric component measuring 96 mm × 58 mm, without active contrast extravasation or an underlying focal lesion. Throughout the admission, the patient remained hemodynamically stable, with no active contrast extravasation on CT and only a moderate decline in hemoglobin levels, from 14.8 g/dL at admission to a nadir of 12.3 g/dL, without requiring transfusion. He was managed with interruption of rivaroxaban and close clinical and biological monitoring alone, with full recovery and no invasive procedure required. A focused review of six comparable published cases of rivaroxaban-associated spontaneous intra-abdominal hemorrhage showed that most required invasive intervention for hemodynamic instability, underscoring the favorable outcome in this hemodynamically stable patient and supporting an individualized, severity-adapted approach to management. The case is notable for the combination of a sizeable perigastric hematoma, moderate hemoperitoneum, absence of active extravasation, hemodynamic stability, and successful non-invasive management. This combination appears to be rarely reported among previously published rivaroxaban-associated intra-abdominal hemorrhages, which predominantly required invasive intervention.
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BibTeX
@article{rachad2026spontaneous,
title = {{Spontaneous Perigastric Hematoma and Hemoperitoneum Associated With Rivaroxaban Therapy: A Case Report and Review of the Literature.}},
author = {Bouya Rachad and Darius Mbina Nzienghi and Naoufal Chouaib and Ahmed Belkouch},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116624},
url = {https://europepmc.org/article/MED/42909392},
note = {CC BY},
}
RIS
TY - JOUR
TI - Spontaneous Perigastric Hematoma and Hemoperitoneum Associated With Rivaroxaban Therapy: A Case Report and Review of the Literature.
AU - Bouya Rachad
AU - Darius Mbina Nzienghi
AU - Naoufal Chouaib
AU - Ahmed Belkouch
PY - 2026
DA - 2026/09/21
JO - Cureus
DO - 10.7759/cureus.116624
UR - https://europepmc.org/article/MED/42909392
AB - Spontaneous hemoperitoneum is a rare but potentially life-threatening complication of direct oral anticoagulant (DOAC) therapy. We report the case of a 59-year-old man receiving long-term rivaroxaban for atrial flutter, previously treated with tricuspid isthmus ablation, who was admitted for atypical chest pain and subsequently developed acute abdominal pain during observation. Contrast-enhanced computed tomography (CT) revealed spontaneous intra-abdominal hemorrhage presenting as a perigastric hematoma with hemoperitoneum, with the perigastric component measuring 96 mm × 58 mm, without active contrast extravasation or an underlying focal lesion. Throughout the admission, the patient remained hemodynamically stable, with no active contrast extravasation on CT and only a moderate decline in hemoglobin levels, from 14.8 g/dL at admission to a nadir of 12.3 g/dL, without requiring transfusion. He was managed with interruption of rivaroxaban and close clinical and biological monitoring alone, with full recovery and no invasive procedure required. A focused review of six comparable published cases of rivaroxaban-associated spontaneous intra-abdominal hemorrhage showed that most required invasive intervention for hemodynamic instability, underscoring the favorable outcome in this hemodynamically stable patient and supporting an individualized, severity-adapted approach to management. The case is notable for the combination of a sizeable perigastric hematoma, moderate hemoperitoneum, absence of active extravasation, hemodynamic stability, and successful non-invasive management. This combination appears to be rarely reported among previously published rivaroxaban-associated intra-abdominal hemorrhages, which predominantly required invasive intervention.
SN - 2168-8184
ER -