Abstract
Rectus sheath hematoma (RSH) is a common entity with no clearly established protocol for management. Existing literature on RSH is outdated and does not incorporate modern technological advances in medicine and imaging. A total of 21 studies were included in this literature review based on PubMed and Google Scholar searches. Modern literature was selected from the last 10 years with the inclusion of three past pieces of literature. We performed a literature review to identify the latest research on RSH management and to consolidate an algorithm to help guide modern RSH treatment. Current RSH classification, scoring system, algorithm, and other predictors for treatment plan are discussed. The best RSH management requires early recognition of RSH followed by the appropriate implementation of conservative management and procedural intervention. The decision on picking the treatment of choice is assisted with the use of predictors, such as hematoma size, rate of hemoglobin drop, and the number of blood transfusions. Further studies are needed to clearly establish predictors among the different types of procedural intervention, and we hope the consolidated algorithm on current literature can help promote the standardization of protocol in the future.
Highlights
BackgroundRectus sheath hematoma (RSH) is formed from a rupture of the inferior or superior epigastric artery most commonly due to traumatic or spontaneous etiology [1]
RSH < 5 cm managed with conservative management (CM), >5 cm with Sx
The best management of RSH is dependent on early RSH recognition and implementation of conservative management
Summary
BackgroundRectus sheath hematoma (RSH) is formed from a rupture of the inferior or superior epigastric artery most commonly due to traumatic or spontaneous etiology [1]. Risk factors for RSH include anticoagulation treatment, paroxysmal coughing, hypertension, advanced age, and previous abdominal surgery [2,3]. Current first-line treatment for RSH is conservative management (CM) involving fluids resuscitation, blood replacement, reversal of anticoagulation, lab monitoring, and bed rest [2,4]. The problem lies in the lack of consensus for predictors that will clearly link a patient to a specific treatment intervention. No clear data has been shown for best predictors to support a standardized protocol due to few prospective studies on this topic. A lack of clear predictors to guide clinicians is problematic when managing patients with RSH [1]. The purpose of this study is to consolidate past and modern literature on RSH and determine a potential algorithm to manage RSH. Modern is defined as the last 10 years of research
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