Retroperitoneal Hematoma after a Rectus Sheath Block

Abstract

derwent laparoscopic left salpingo-oophorectomy for an endometriotic cyst. After induction of general anesthesia, rectus sheath block was performed using a 21-gauge hypodermic needle for postoperative analgesia around the umbilical wound. A four-point injection technique was used; however, blood was aspirated, and the injection was abandoned. Laparoscopy was performed using the closed method, and there was no evidence of injury or intraabdominal bleeding. At conclusion of the procedure, a retroperitoneal hematoma was noticed in the right paraaortic region extending from the level of the umbilicus down to the pelvic brim (Figure 1). A small puncture site with mild bleeding was seen over the hematoma at about the level of the umbilicus (Figure 2), suggesting injury was unlikely due to insufflating needle or entry trocar. Conservative management was elected as there was no apparent enlargement of the hematoma. Postoperative computed tomography of the abdomen revealed a retroperitoneal density 2-cm thick in the periaortic region and anterior to the inferior vena cava in the infra-renal portion down to the bifurcation, compatible with the retroperitoneal hematoma. The patient recovered fully, and the hematoma resolved spontaneously.