Rectus Sheath Hematoma—a Hitherto Less Described Entity

Abstract

Rectus sheath hematoma is a rare condition that is manifested by abdominal wall pain and stiffness in the abdominal wall. It is usually a result of the rupture of the epigastric vessels or rectus muscle into the lower part of the umbilical region. Surgical intervention is rarely required due to diagnosis and uncontrollable growth. Twenty-two patients who were diagnosed and followed up with rectus sheath hematoma between January 2010 and January 2020 in Dicle University Medical Faculty, Clinic of General Surgery, were retrospectively reviewed for demographic features, clinical and radiological findings, and length of hospital stay. The most common complaints of patients with rectus sheath hematoma were abdominal wall pain, swelling, ecchymosis, and mass on the abdominal wall. The average age of the patients was 63 (22–78) years. Twenty of the patients were women and 2 of them were men. None of the patients had a history of trauma, and all were using anticoagulant drugs. In radiological imaging, types of rectus sheath hematoma were type 1 in twelve patients, type 2 in seven, and type 3 in three. Firstly, anticoagulant medications used by patients were discontinued. Then, all patients, except two who were undertaken surgery, were treated conservatively. The reason for the surgery was rapid and widespread growth of hematoma. The average length of hospital stay was 7 (6–13) days. At the end of the first month after diagnosis and treatment, computed tomography revealed that the mass disappeared in patients with type 1 rectus sheath hematoma, while the other patients had a marked reduction in mass size. In patients with an abdominal wall pain, anemia, a mass/ecchymosis on anterior abdominal wall, and history of anticoagulant medication, rectus sheath hematoma should be considered in the differential diagnosis. Early diagnosis of rectus sheath hematoma ensures the prevention of unnecessary surgical interventions and determines the success of conservative treatment.