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Rectus sheath hematoma: three case reports.

Kapan S, Turhan AN, Alis H, Kalayci MU, Hatipoglu S, Yigitbas H, Aygun E - J Med Case Rep (2008)

Bottom Line: It could occur spontaneously or after trauma.They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.Main therapy is conservative management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery, Istanbul, Turkey. selinkapan@gmail.com

ABSTRACT

Introduction: Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.

Case presentation: We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.

Conclusion: Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.

No MeSH data available.


Related in: MedlinePlus

CT appearance of rectus sheath hematoma on the left side of the abdomen.
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Figure 3: CT appearance of rectus sheath hematoma on the left side of the abdomen.

Mentions: A 76 years old woman presented to the Emergency Department with complaints of abdominal pain, and an abdominal mass in the right upper quadrant. She had a history of congestive heart failure, chronic atrial fibrillation, chronic obstructive lung disease, ischemic cerebrovascular disease and myocardial infarction. The patient had been taking warfarin sodium 5 mg/day for atrial fibrillation for 2 years without medical supervision. On physical examination painful mass in the left lower quadrant and suprapubic region of the abdomen was observed. Ausculatation of the abdomen revealed hypoactive bowel sound. Mean arterial pressure was 140/80 mmHg, pulse rate 118/min, hemoglobin level 13.32 g/dL, hematocrit 30.26%, platelet 199000/UL, PT: 79.2 sec, aPTT: 56 sec, INR: 6.68. The other biochemical tests were normal. Abdominal CT revealed rectus sheath hematoma (Figure 3). During the follow up period 6 units of fresh frozen plasma was administered. Due to the hemodynamic stability patient was referred to the Internal Medicine Department.


Rectus sheath hematoma: three case reports.

Kapan S, Turhan AN, Alis H, Kalayci MU, Hatipoglu S, Yigitbas H, Aygun E - J Med Case Rep (2008)

CT appearance of rectus sheath hematoma on the left side of the abdomen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2254639&req=5

Figure 3: CT appearance of rectus sheath hematoma on the left side of the abdomen.
Mentions: A 76 years old woman presented to the Emergency Department with complaints of abdominal pain, and an abdominal mass in the right upper quadrant. She had a history of congestive heart failure, chronic atrial fibrillation, chronic obstructive lung disease, ischemic cerebrovascular disease and myocardial infarction. The patient had been taking warfarin sodium 5 mg/day for atrial fibrillation for 2 years without medical supervision. On physical examination painful mass in the left lower quadrant and suprapubic region of the abdomen was observed. Ausculatation of the abdomen revealed hypoactive bowel sound. Mean arterial pressure was 140/80 mmHg, pulse rate 118/min, hemoglobin level 13.32 g/dL, hematocrit 30.26%, platelet 199000/UL, PT: 79.2 sec, aPTT: 56 sec, INR: 6.68. The other biochemical tests were normal. Abdominal CT revealed rectus sheath hematoma (Figure 3). During the follow up period 6 units of fresh frozen plasma was administered. Due to the hemodynamic stability patient was referred to the Internal Medicine Department.

Bottom Line: It could occur spontaneously or after trauma.They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.Main therapy is conservative management.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery, Istanbul, Turkey. selinkapan@gmail.com

ABSTRACT

Introduction: Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.

Case presentation: We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.

Conclusion: Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.

No MeSH data available.


Related in: MedlinePlus