Introduction: Retroperitoneal hematoma (RPH) is a potentially fatal condition frequently encountered in patients with blunt abdominal injury, particularly in the context of polytrauma. Due to its deep location and typically nonspecific clinical presentation, early diagnosis is challenging. This study, which aims to present the etiology, classification, diagnostic approach, treatment modalities, and clinical outcomes of RPH in a high-volume trauma center, reports novel findings that can significantly add to the optimization of management of this entity. Materials and Methods: We conducted a retrospective review of 30 consecutive polytrauma patients with radiologically confirmed RPH who were admitted to the National Trauma Centre between July 1, 2006, and November 30, 2006. Prospectively collected data included patient demographics, injury mechanism, hematoma site (pelvic, central, or lateral), admission hemodynamic status, treatment modality (nonoperative vs. operative), and in-hospital outcomes. Results: There were 24 males and six females with a median age of 34 years. Motor vehicle collisions were responsible in 72% of cases. Hematomas were confined to the pelvic compartment in 44%, central area in 33%, and lateral retroperitoneum in 23% of cases. Nonoperative management (NOM) was employed in 21 hemodynamically stable patients (71%), all of whom remained stable without secondary hemorrhage. Nine patients (29%) required operative management (OM) due to ongoing hemodynamic instability; all underwent emergency laparotomy with pelvic packing. The principles of damage control actively prevent hematoma formation. Overall mortality was 10% (n=3), all of which were due to central hematomas and severe multi-organ trauma. Conclusions: RPH management following blunt trauma needs to be guided by hematoma location and hemodynamic status. With the finding that NOM is not only safe but also highly effective in stable patients, particularly in those with lateral or pelvic hematomas, clinicians need reassurance and trust in this approach. Central hematomas with persistent instability need early surgery. Routine evacuation of hematomas is not recommended due to the high risk of uncontrollable bleeding.