Idiopathic Adrenal Hematoma as an Unusual Cause of Acute Abdomen: A Case Report.

Idiopathic adrenal hematoma is a rare and diagnostically challenging condition that may present as an acute abdomen and closely resemble more common surgical and medical emergencies. We report a case of a 45-year-old male who presented with a sudden onset of severe abdominal pain in the absence of trauma, anticoagulant use, or any known systemic disease. Physical examination revealed localized abdominal tenderness, and routine laboratory investigations, including hematological, biochemical, coagulation, and endocrine testing, were within normal limits. Cross-sectional imaging demonstrated findings consistent with acute adrenal hemorrhage, with no evidence of an underlying functional or malignant adrenal lesion. The patient was managed conservatively with analgesia, close clinical observation, and multidisciplinary care, resulting in an uncomplicated clinical course and progressive symptom resolution. Interval imaging showed regression of the adrenal lesion, supporting the diagnosis of idiopathic adrenal hematoma. This report highlights the importance of considering adrenal hemorrhage in the differential diagnosis of acute abdominal pain, the role of imaging and hormonal evaluation in excluding secondary causes, and the utility of non-operative management with appropriate follow-up in clinically stable patients.