Rectus Sheath Hematoma

Author(s): Ugur KESICI, DERICI Serhan

PURPOSE: Spontaneous rectus sheath hematoma (RSH) is a rarely seen event. Complaints of abdominal pain are observed frequently and mass in the abdominal wall are encountered in patients. The most important risk factors in the development of the disease are anticoagulant drug use and coughing. In this case report two patients who did not use anticoagulants, diagnosed with RSH are discussed.CASE REPORT: One of the patients was a 70 years old and the other was a 88 years old woman. Complaints of abdominal pain and mass in the abdominal wall were present in both patients. There was no anticoagulant drug in the anamnesis of the patients. Both patients were followed up conservatively. Patients were discharged respectively on the 8th and the 7th day since there were no complications during their follow-ups.RESULT: RSH is a rarely seen event that should definitely be considered during the differential diagnosis of acute abdomen. Although the disease is generally seen in old patients using anticoagulants, it can be encountered, as such as in this case report, without the use of anticoagulants. The treatment of disease is generally conservative. Since mortality due to bleeding can be encountered rarely, hemodynamic findings of the patients should be followed carefully.

1. De Martino C, Martino A, Giamattei RM, Viola G, Pisapia A, Fatigati G. [Spontaneous rectus sheath hematoma: a rare condition with uneasy diagnosis and multidisciplinary treatment. Report of 5 cases and review of literature]. Ann Ital Chir 2011;82:399-404
2. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore) 2006;85:105-10
3. Dag A, Ozcan T, Yurkmenoglu O et al. Spontaneous rectus sheath hematoma in patients on anticoagulation therapy. Ulus Travma Acil Cerrahi Derg 2011;17:210-4
4. Alla VM, Karnam SM, Kaushik M, Porter J. Spontaneous rectus sheath hematoma. West J Emerg Med 2010;11:76-9
5. Carkman S, Ozben V, Zengin K, Somuncu E, KarataÅŸ A. Spontaneous rectus sheath hematoma: an analysis of 15 cases. Ulus Travma Acil Cerrahi Derg 2010;16:532-6
6. Aykan A, Oguz A, Yildiz M, Ozkan M. A rare case of spontaneous rectus sheath haematoma in a patient with mechanical prosthetic aortic and mitral valves. Cardiovasc J Afr 2012; 12;23(6):e14-5
7. Kesici U, Kesici S, Polat E, Agca B, Turkmen UA, Ozcan D, Sari MK. Effects of intra-abdominal pressure increase on intestinal ischemia and bacterial translocation in experimental sepsis model. Saudi Med J. 2011;32:813-7
8. Jafferbhoy SF, Rustum Q, Shiwani MH. Abdominal compartment syndrome--a fatal complication from a rectus sheath haematoma. BMJ Case Rep. 2012 Apr 2;2012. pii: bcr1220115332. doi: 10.1136/bcr.12.2011.5332
9. Cremades M, Garcés B, Arméstar F, Balibrea JM. Multiorgan failure secondary to intraabdominal compartmental syndrome due to rectus muscle sheath hematoma. Med Intensiva. 2012 Dec 19. doi:pii: S0210-5691(12)00283-5