Spontaneous pelvic hemorrhage is defined as the presence of intra-abdominal bleeding without a traumatic cause. This condition is rare but can be catastrophic if not promptly diagnosed and treated. It may present with severe abdomino-pelvic pain and distension associated with decreased hematocrit. However, these signs might not always be present and so radiological imaging plays a pivotal role in this scenario, with ultrasound and especially Computed Tomography allowing for detailed detection of the site of bleeding and identification of the feeding vessels. Common sources of spontaneous pelvic hemorrhage include visceral (intestinal), gynecologic, and vascular diseases. If active bleeding is detected, conservative management should be abandoned in favor of surgery or endovascular embolization.