Rectus sheath hematoma: three case reports

Selin Kapan,Mustafa U Kalayci,Ersan Aygun,Sinan Hatipoglu,Hakan Yigitbas,Ahmet N Turhan,Halil Alis

doi:10.1186/1752-1947-2-22

Abstract

IntroductionRectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.Case presentationWe reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.ConclusionRectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.

Highlights

Rectus sheath hematoma is an uncommon cause of acute abdominal pain
Case presentation: We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography
Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies

Summary

Conclusion

Rectus sheath hematoma is a rarely seen entity often misdiagnosed as acute abdomen. Prompt history taking with careful physical examination and appropriate imaging studies help the correct diagnosis avoiding unnecessary laparotomies. CT seems to be the most appropriate choice of imaging. Management is conservative in most cases including bed rest, analgesia, intravenous fluid replacement and blood transfusions when necessary

Introduction

Discussion