Abstract
Background Rectus sheath hematoma is a rare self-limited presentation that has become a concern in hospitalized COVID-19 patients receiving anticoagulant therapies. Method A retrospective multicentric study was conducted in referral hospitals affiliated with the Tehran University of Medical Science, Tehran, Iran, between June and August 2021. Patients with a confirmed diagnosis of COVID-19 that were complicated with rectus sheath hematoma during hospitalization were included. Median (lower quartile to upper quartile) was used to report the distribution of the results. Result This study was conducted on nine patients with confirmed COVID-19 pneumonia, including eight females and one male. The severity of viral pneumonia was above average in eight patients. The median age and median body mass index were 65 (55.5 to 78) years and 29.38 (23.97 to 31.71) kg/m2. The duration of anticoagulant therapy was 10 (6 to 14) days, and the median length of hospital stay was 20 (10 to 23.5) days. Rectus sheath hematoma occurred after a median reduction of 4 (2.7 to 6.6) units in blood hemoglobin. Although 66.7% received ICU care and all of them were under full observation in well-equipped hospitals, the mortality rate was 55.6%. Conclusion In summary, increased levels of inflammatory markers such as lactic acid dehydrogenase along with an abrupt decrease in blood hemoglobin in COVID-19 patients should be considered as predisposing factors for rectus sheath hematoma, especially in patients with moderate to severe COVID-19 pneumonia under anticoagulant therapy. This complication had been considered a self-limited condition; however, it seems to be fatal in patients with COVID-19 pneumonia. Further studies in larger sample sizes should be conducted to find out suitable management for this complication.
Highlights
Rectus sheath hematoma (RSH) is a rare cause of abdominal pain in hospitalized patients. is condition commonly occurs after either a rupture of abdominopelvic arteries and their branches, especially during anticoagulation therapy or the tear of the rectus abdominis muscle [1].Studies have warned against the development of RSH following anticoagulant treatment
A diagnosis of COVID-19 was made according to the chest computed tomography (CT) scan and/or real-time PCR upon admission. e severity of pulmonary involvement was assessed by a professional radiologist upon admission
We present major RSH in nine confirmed COVID-19 patients on prophylactic or therapeutic anticoagulation treatment. e median and interquartile range were used to report the distribution of the results
Summary
Rectus sheath hematoma (RSH) is a rare cause of abdominal pain in hospitalized patients. Studies have warned against the development of RSH following anticoagulant treatment It accounts for about 1.5–2% of the cases of unexplained abdominal pain in hospitalized patients [2]. Rectus sheath hematoma is a rare self-limited presentation that has become a concern in hospitalized COVID-19 patients receiving anticoagulant therapies. Patients with a confirmed diagnosis of COVID-19 that were complicated with rectus sheath hematoma during hospitalization were included. Increased levels of inflammatory markers such as lactic acid dehydrogenase along with an abrupt decrease in blood hemoglobin in COVID-19 patients should be considered as predisposing factors for rectus sheath hematoma, especially in patients with moderate to severe COVID-19 pneumonia under anticoagulant therapy. Further studies in larger sample sizes should be conducted to find out suitable management for this complication
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