Idiopathic retroperitoneal hematoma is a rare, but potentially life threatening cause of an acute surgical abdomen. Initially diagnosis may be overlooked, leading to unnecessary exploration, which may have implications for prognosis of the patient. An enhanced Computer Tomography (CT) scan of the abdomen is the principle method of diagnosis. However, as in our case, laparoscopic management of the acute abdomen can play a vital role in this group of patients. Importantly, early diagnosis and vigilant conservative management can improve the outcome in idiopathic retroperitoneal hematoma.