Hemodynamic Instability in Emergency Department: Giant Rectus Sheath Hematoma and Point-of-Care Ultrasonography.

Yagmur Ay,Tuncer Temel,Mustafa Emin Canakci,Engin Ozakin,Nurdan Acar

doi:10.7759/cureus.13669

Abstract

Iatrogenic rectus sheath hematoma (RSH) developed after paracentesis is a rare but life-threatening complication. Mortality rates of patients may increase due to delays in treatment and comorbid conditions. In this article, we present the case of a patient who was unstable in the emergency department and was diagnosed with RSH using point-of-care ultrasonography (POCUS). The importance of POCUS has increased as hematoma manifestations of patients with severe ascites tend to be obscured. POCUS has varied uses in the emergency department, and in this article we emphasize the use of POCUS in a life-threatening case of RSH.

Highlights

Rectus sheath hematoma (RSH) occurs as a result of accumulation of blood in the rectus sheath due to rupture of the epigastric vessels or tear in the muscle fibers
RSH is a rare presentation in the emergency department (ED), it should be considered in critically ill patients
In previous case reports related to RSH, the area of hematoma was evident on physical examination; the distinction was not clear in our case because of the prominent abdominal distension [4]

Summary

Introduction

Rectus sheath hematoma (RSH) occurs as a result of accumulation of blood in the rectus sheath due to rupture of the epigastric vessels or tear in the muscle fibers. The use of POCUS as a rapid, noninvasive, and inexpensive method of differential diagnosis of critical patients will continue to increase. In this case report, the diagnosis of iatrogenic RSH was made by POCUS in the ED and treatment was initiated. The patient had a known history of liver cirrhosis and had undergone paracentesis three days ago due to widespread ascites. View video here: https://youtu.be/dvU5WFjNfWg Upon erythrocyte suspension transfusion, the patient’s tachycardia improved and blood pressure was 90/60 mmHg. RSH with diffuse ascites and 11 × 11 cm active extravasation and contrast transition was observed on abdominal computed tomography, which was performed for determining the area of hemorrhage (Figure 2). The patient expired due to cardiac arrest which occurred 48 hours after admission

Discussion

Conclusions

Findings

Disclosures