{
  "abstract": "A man in his 80s presented with acute abdominal pain and cold sweats. His medical history included Parkinson’s disease, diabetes mellitus, constipation and insomnia. He had been prescribed 600 mg/day of levodopa, 64.8 mg/day of carbidopa hydrate, 600 mg/day of droxidopa, 40 mg/day of istradefylline, 7.5 mg/day of selegiline hydrochloride, 20 mg/day of propiverine hydrochloride, 25 mg/day of opicapone, 22.5 mg/day of rotigotine, 24 mg/day of sennoside A・B calcium and 15 mg/day of suvorexant. He was not on antiplatelet or anticoagulant therapy. Vital signs showed a temperature of 36.4°C, a heart rate of 95 bpm, a blood pressure of 92/59 mm Hg and an SpO₂ of 96% on room air. Physical examination revealed abdominal tenderness, and laboratory tests showed a haemoglobin level of 12.5 g/dL, CRP 0.86 mg/dL and d-dimer 2.4 µg/mL. Contrast-enhanced CT of the abdomen revealed a haematoma extending from the peripancreatic region to the retroperitoneum, with no evidence of active extravasation ( figure 1). Based on these findings, he was diagnosed with spontaneous retroperitoneal haematoma (SRH) and initially managed conservatively as an outpatient. On day 8, although he had no symptoms such as vomiting or abdominal tenderness and no unstable vital signs, follow-up testing showed a haemoglobin level of 10.6 g/dL, CRP 7.67 mg/dL and D-dimer 5.0 µg/mL. It was suggested that SRH was getting worse, prompting hospital admission. On day 9, he developed recurrent vomiting. A repeat CT scan demonstrated intestinal dilation and fluid accumulation proximal to the descending duodenum, consistent with duodenal obstruction secondary to SRH (figure 2). Conservative management, including nasogastric decompression, resolved his symptoms. On day 13, drainage of fluid was gradually decreasing and drinking was started. On day 26, it was confirmed that gut distension of the X-ray image was improved. A follow-up CT scan 3 months later confirmed complete resolution of the SRH.",
  "authors": [
    {
      "affiliations": [
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, Japan",
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa Prefecture, Japan"
      ],
      "name": "Hiroaki Yamashita"
    },
    {
      "affiliations": [
        "Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan",
        "Department of General Medicine, Yokohama City University Medical Center, Yokohama, Kanagawa Prefecture, Japan"
      ],
      "name": "Kosuke Ishizuka"
    },
    {
      "affiliations": [
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, Japan",
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa Prefecture, Japan"
      ],
      "name": "Takuya Otsuki"
    },
    {
      "affiliations": [
        "Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, Japan",
        "Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa Prefecture, Japan"
      ],
      "name": "Tsubasa Sakai"
    }
  ],
  "title": "Spontaneous retroperitoneal haematoma and delayed duodenal obstruction",
  "uid": "f77a6aa1-0619-5b3e-8f8a-1b7ca6344710"
}