A Rare Case of Apixaban-Related Spontaneous Perinephric Hematoma Complicated by Multiorgan Dysfunction.

Spontaneous perinephric hematomas are rare but potentially life-threatening events, often associated with anticoagulation therapy. We report a case of a 63-year-old male patient on apixaban for paroxysmal atrial fibrillation who presented with acute abdominal and flank pain and was found to have a large left-sided perinephric hematoma. His clinical course was complicated by acute kidney injury, ileus, respiratory failure requiring mechanical ventilation, and eventual death from hypoxic respiratory failure and cardiac arrest. This case underscores the diagnostic and therapeutic challenges in managing spontaneous retroperitoneal hemorrhage, especially in the setting of anticoagulation, and highlights the importance of early recognition and multidisciplinary management.