Background: Spontaneous perinephric hematoma with no associated pathology or provocation is a rare clinical phenomenon. The hematoma requires a two-year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. Aims: Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2-year follow up. Case Presentation: A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. Conclusion: The acute management strategy is favorable in such condition, as the hematoma remains under tamponade in the retroperitoneal space, regardless of the size and organ displacement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.

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