Spontaneous Abdominal Wall Hematoma

Abstract

A 56-year-old woman presented to our emergency department because of sudden onset of severe left lower abdominal pain. She suffered a severe cough for 2 weeks and denied using anticoagulation agents. Physical examination showed some purple-bluish lesions in her left abdominal wall (Figure A). A big tender mass was palpated in her left lower abdomen. Her hemoglobin level was 10.1 g/dL. Abdominal ultrasound showed a 7-cm hyperechoic mass in the left abdominal wall (Figure B). Abdominal computed tomography showed a large hematoma with contrast extravasation in the left lateral abdominal wall (Figure C, arrow). Emergency transarterial embolization was performed and her abdominal wall bleeding was halted. She underwent a debridement for hematoma and was discharged uneventfully. Spontaneous abdominal wall hematoma is an unusual entity and its most common presentations are acute abdominal pain, vomiting, and fever. Physical examination showed cutaneous ecchymosis and an abdominal palpable mass. Predisposing factors of this disease include severe cough, vomiting, or use of anticoagulants. Abdominal ultrasound and computed tomography are useful modalities to evaluate active bleeding from ruptured arteries. Conservative treatment is acceptable for patients with stable hemodynamics, but surgery is restricted for patients with complications (rupture, infection, or hematoma progression). Angiography with embolization can control bleeding and avoid surgical intervention.