Objective: To investigate the clinical features, imaging manifestation and treatment strategies of retroperitoneal leiomyosarcoma, so as to provide reference for the diagnosis and treatment of similar cases. 
Methods: The clinical data of one admitted patient with retroperitoneal leiomyosarcoma was analyzed retrospectively, and the relevant literature was reviewed.  
Results: The patient had abdominal pain and anemia, and the preoperative imaging examination indicated a malignant tumor with hemorrhage in hypogastric region. The patient underwent fluid replacement therapy and interventional embolization first, and then ultrasound-guided puncture and drainage to avoid the occurrence of abdominal compartment syndrome. After tumor size reduction and anemia correction, the tumor was completely resected, and the pathological diagnosis was leiomyosarcoma. Postoperative follow-up was conducted for 
16 months, and the patient had an uneventful recovery.  
Conclusion: Retroperitoneal leiomyosarcoma is a rare malignant tumor, which has an insidious onset and is more likely to develop recurrence and metastasis. Complete surgical excision is the main treatment method, which in combination with multimodality therapy such as chemotherapy and radiotherapy can improve the prognosis of patients.