This study examines the accumulation, distribution, and mobility of Potentially Toxic Elements (PTEs) in the sediments of a low-lying coastal drainage network (Ravenna, Italy). The aim is to understand the geochemical processes occurring between drainage water and canal bed sediments and assess factors affecting and driving PTE distribution and enrichment in these environments. A geochemical database resulting from the analysis of 203 drainage sediment samples was analyzed using Principal Component Analysis and compared to undisturbed near-surface sediment samples from the same depth and depositional environment. The results reveal PTEs exceeding national regulation limits. Distance from the sea, electrical conductivity of drainage water, and fertilizer use were identified as the main driving factors. The primary mechanisms for PTE precipitation (As, Co, Mo) and subsequent enrichment in the sediments is attributed to the absorption on Fe- and Mn-oxyhydroxides (HFO and HMO), particularly in high salinity areas near the coast. While Cu, Zn, Pb, Cr, and V also have affinity for HFO and HMO, their adsorption efficiency decreases due to the competition with salt-derived cations during ongoing salinization processes. Anthropogenic sources, including agriculture, hunting activities, traffic dust, and railways, contribute to the local abundance of other elements (Cr, Ni, Cu, Zn, Pb, and Sn). This paper's significant progress lies in assessing the concurrent interactions of chemical and physical processes that drive PTE distribution and accumulation in reclaimed low-lying coastal plains. The findings are significant for assessing PTE accumulation risks and sediment toxicity in coastal areas affected by water salinization, drainage, and subsidence, providing valuable information to water management institutions globally.