Case Of Rectus Sheath Hematoma Research Articles

Case Report: Rectus Sheath Hematoma in a Pregnant Women

Rectus sheath hematoma is a very uncommon cause of acute abdominal pain, especially during pregnancy. Misdiagnosis is likely due to the lack of specific symptoms, which could put the patient and her fetus in danger.. A patient came with sudden severe left upper abdominal pain with history of cough for few days. She was referred from other hospital and diagnosed there as 32 weeks pregnancy preeclampsia with severe disease with HELLP syndrome. Uterus was tender and more prominent on left side, and patient was not in labour. Provisional diagnosis was abruptio placenta with concealed haemorrhage or rupture uterus. But after laparotomy it was diagnosed as a case of rectus sheath haematoma(RSH). Different imaging modalities such as Ultrasonography and CT are the diagnostic methods. Active bleeding can be managed either surgically by evacuating the haematoma and ligating the bleeding vessels. We managed the patient by laparotomy and blood and blood product transfusion and by multidisciplinary approach, but the patient developed multiorgan failure and expired on 16 th POD. The clinical and diagnostic symptoms of rectus sheath hematoma are highlighted in this case report. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 71-74

2249 Rectus Sheath Hematoma Post Abdominal Paracentesis: A Rare Complication

INTRODUCTION: Rectus sheath hematoma (RSH) is a very rare complication after abdominal paracentesis especially in patients who do not take antiplatelet or anticoagulants. We presented a case of rectus sheath hematoma post paracentesis in a patient without obvious risk factors. CASE DESCRIPTION/METHODS: A 56-year-old male with past medical histories of chronic diastolic congestive heart failure and end-stage renal disease (ESRD) on hemodialysis presented with abdominal pain after abdominal paracentesis for ascites. 4.3 L of yellow ascitic fluid was drained in the first attempt of ultrasound-guided paracentesis. Abdominal distension on the right flank was also noticed. Vital signs were stable. Abdominal exam showed moderate tenderness on right flank, no guarding, no rebound tenderness, no bruising. ESRD was believed to be the cause of ascites. He received hemodialysis one day prior to the procedure. He is not on any antiplatelet or anticoagulation therapy. Computed tomography scan of abdomen showed right rectus sheath hematoma 14 × 9 cm (Figure 1). Labs on admission showed Hemoglobin (Hb) of 9.2 g/dL (compared to baseline Hb of 10.8 g/dL), Platelet count 192000 /uL, PT 13.9 secs, PTT 34.6 secs, and INR 1.22, BUN 42 mg/dL, Creatinine (Cr) 5.6 mg/dL (similar to baseline Cr). Interventional radiologist was emergently consulted and performed embolization which found extravasation from the right iliolumbar artery (Figure 2). Coil embolization was done successfully. On post-embolization day 3, Hb continued to drop to 5.7 g/dL. He developed hypotension. Surgery team was notified and brought the patient to operation room for exploratory laparotomy. Intraoperative findings revealed that 2 L of hematoma was evacuated from the patient’s rectus sheath. No active bleeding was immediately noted. Upon the exploration of the anterior wall toward the medial side of the incision, a small bleeding vein was noted and ligated. Vital signs became stable after the operation. He was discharged without postoperative complications. DISCUSSION: Large RSH is a rare complication of paracentesis. It can also develop in a patient without obvious bleeding risk factors. Clinicians should watch for this potential complication when a patient presents with an abdominal mass or abdominal pain without other particular symptoms after paracentesis. RSH is a self-limited condition; however, our case suggests that RSH may take an unpredictable course and may not be successfully managed with a conservative approach.

398. Catastrophic rectus sheath haematoma in pregnancy

Introduction We present a case of rectus sheath haematoma (RSH) resulting in intra-uterine fetal demise, in a woman who was therapeutically anti-coagulated for a massive pulmonary embolism. Objectives This relatively rare complication of anticoagulation therapy is easily misdiagnosed in the pregnant population and the publication of this case seeks to highlight the diagnostic and management challenges faced by obstetricians. Case A woman receiving anticoagulant treatment for a large saddle pulmonary embolus diagnosed at 34 weeks gestation, complained of increasing abdominal pain and swelling at 37 weeks gestation. The pain was associated with a fall in haemoglobin concentration and ultrasonography was consistent with a large rectus sheath haematoma (10 × 10 × 2 cm). Despite initial conservative management her condition deteriorated and she collapsed as a result of hypovolaemia. Intra-uterine fetal demise was diagnosed and a caesarean section was performed with evacuation of a 2000 ml RSH and ligation of the inferior epigastric artery. Methods A pubmed literature search and review of results. Results There are few reported cases of RSH in pregnancy; the key discussion points are addressed below. Discussion RSH is a rare presentation, more commonly found in patients who are anticoagulated. Risk factors for the development of RSH include conditions which increase the intra-abdominal pressure, such as coughing. The patient presented above had been complaining of a cough, and subsequent imaging confirmed a lobar pneumonia. These features, in combination with her anticoagulation predisposed her to the development of a RSH. In the context of a haemodynamically stable patient the management of RSH should be conservative, hence the importance of accurate diagnosis and early management to avoid unnecessary laparotomy which could result in further bleeding. In unstable patients surgical and/or radiological intervention is indicated. Conclusion We present a rare case of antepartum rectus sheath haematoma requiring surgical intervention.

A Case of Rectus Sheath Hematoma Due to Anticoagulants after Total Knee Arthroplasty

Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-year-old female patient after total knee arthroplasty (TKA) due to osteoarthritis. Postoperation, residual DVT was noted in the right soleus vein on ultrasonography of the veins of the lower limbs. Anticoaglation was started 7.5 mg/day Arixtra for treatment of DVT. Anticoaglation was administered throughout rehabilitation, and abdominal pain developed on postoperative day 9. Since respiratory distress developed on day 10, then thoracoabdominal contrast CT was performed. Although no PE was observed, a hematoma was detected in the rectus sheath, and it perforated into the abdominal cavity. The hemoglobin level was reduced by about 4 g/dL, and the patient was admitted to the ICU. Surgical treatment was not performed, anticoagulant treatment was discontinued, and conservative treatment was administered. During management in the ICU, a total of 24 units of red blood cells were transfused. Conclusions: Rectus sheath hematoma should be in mind of surgeons during differential diagnosis of acute abdominal pain especially in patients receiving anticoagulants. Early recognition can be of great importance for patients’ recovery, preventing from severe complications. Management is usually supportive although surgical intervention in some patients should be considered.

Rectus Sheath Hematoma—A Rare and Dangerous Complication of Anticoagulation Therapy<br/>—A Case Report and Review of Current Literature

Rectus sheath hematoma (RSH) is a rare bleeding site which can be life-threatening. Our aim was to analyze clinical features, diagnosis, treatment and outcome of these cases in a general hospital. Results: During a period of 24 months, 8 cases of RSH were diagnosed (0.1% of all inpatients). Mean age was 79.4 years (y, SD +/- 14.1). 75% were female. 7 patients (pts) were on therapy with oral anticoagulants (OAC), 2 had a history of additional therapy with aspirin (ASA), 4 had low molecular weight heparin (LMWH) for bridging of OAC therapy. 4 pts had INR values between 3.1 - 4.4. One pt with liver cirrhosis (Child A), mild thrombocytopenia had ASA and LMWH prophylactically. Five pts (63%) were coughing. Main symptom was localized pain in 7 pts. One pt was incidentally diagnosed on a CT scan performed for different reason. 7 pts had a palpable mass of the abdominal wall. 5 RSH were diagnosed with CT, 2 with ultrasound, 1 clinically. All pts were treated conservatively. In 7 pts vitamine K and Beriplex&#174 was substituted to reverse OAC. 4 pts received blood transfusions (1 - 4 units). The mean change of hemoglobin (Hb) was 37 g/l (SD +/- 22 g/l). The renal function was impaired in 7 pts (mean creatinine clearance 51 ml/min +/- 12.4) and declined further. 3 out of 8 pts died (38%, age 90 - 92 y, all female). In these patients, the observed change in Hb was 42 - 58 g/l. 2 pts had combination of VKA and LMWH. 1 pt had VKA only. Conclusion: Acute abdominal pain in pts with any form of OAC or therapy to inhibit platelet function should always raise suspicion about RSH. Extensive blood loss, shock and aggravation of renal failure can be fatal. In majority of cases, the hematoma is palpable and should prompt further examination of the abdominal wall. It is crucial to normalize coagulation parameters and to correct intravascular volume depletion to avoid shock and further decline of renal failure.

A Case of Rectus Sheath Hematoma and Pelvic Cavity Hematoma Induced by Dalteparin Injection

Rectus sheath hematoma (RSH) is an uncommon condition caused by hemorrhage into the rectus sheath. RSH is characterized by abdominal pain and an abdominal mass. This condition is associated with old age, childbirth, abdominal surgery, severe coughing, severe sneezing, anticoagulation therapy, and/or coagulation disorders. We report herein a case of RSH and pelvic cavity hematoma that was induced by dalteparin injection in a 77-year-old woman with pulmonary embolism and deep vein thrombosis, and who was successfully treated by conservative management. (Korean J Med 2013;85:530-534)

A case of rectus sheath hematoma due to Foley catheterization after acute urinary retention

Rectus sheath hematoma (RSH) is generally not considered a reason for abdominal pain and its incidence as a cause of abdominal pain is unknown. RSH is a rarely seen but nonetheless an important disease causing abdominal pain. During contractions of the rectus abdominis muscle, the inferior epigastric artery must glide with the muscle to avoid tearing. When the inferior epigastric artery is torn, blood dissects along the rectus sheath leading to hematoma formation. We report a case of spontaneous rectus sheath hematoma due to Foley catheterization after acute urinary retention. In the current case, the rectus abdominis muscle stretched because of overdistended bladder. After the patient was catheterized to drain urinary retention, the rectus abdominis muscle contracted abruptly, and vessels were injured by rapid muscle contraction caused by Foley catheterization.

An unusual case of abdominal pain, hematuria, and sepsis following renal transplantation

An unusual case of abdominal pain, hematuria, and sepsis following renal transplantation

A Case of Rectus Sheath Hematoma Complicated with Hypovolemic Shock in a Critically-Ill Patient

Rectus sheath hematoma (RSH) is a rare condition caused by hemorrhage into the rectus sheath. It is usually associated with severe cough, abdominal surgery, coagulopathy, and anticoagulation treatment. RSH can be difficult to diagnose and can be misdiagnosed as acute appendicitis, as diverticulitis, or as an ovarian mass. Although RSH usually presents as a benign condition, it can be life threatening, especially in the critically-ill patient. Here, we report a case of fatal RSH due to hypovolemic shock in a critically-ill 73-year-old woman, who had received heparin treatment due to acute myocardial infarction in the intensive care unit and who had been successfully treated by conservative management.

A case of rectus sheath hematoma caused by yoga exercise

Rectus sheath hematoma is a relatively rare condition but a significant cause of acute abdominal pain. The acute abdominal pain associated with rectus sheath hematoma can mimic several conditions, such as appendicitis, intestinal problems (obstruction, perforation, hernia, malignancy), and gynecologic disease (ovarian cyst, torsion, tubo-ovarian abscess, ectopic pregnancy). Correct diagnosis and subsequent treatment depends on careful history taking and appropriate use of diagnostic tools to avoid unnecessary laparotomy. We report a case of rectus sheath hematoma due to noncontact strenuous exercise, yoga, that mimicked gynecologic diseases.

A Case of Rectus Sheath Hematoma and Intraperitoneal Hematoma Induced by Cough

Rectus sheath hematoma (RSH) is a rare condition that’s caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin. (Tuberc Respir Dis 2008;65: 212-215)

Rectus sheath hematoma complicating low‐molecular weight heparin therapy

Rectus sheath hematoma (RSH) is an uncommon but serious bleeding complication of anticoagulant therapy that has received little attention in the literature. Two cases of RSH among recent admissions to an inpatient medicine service and four archival cases were reviewed. All six patients were on low-molecular weight heparin (LMWH) therapy. Five of the six patients had a creatinine clearance of 40 ml/min or less, and five also had cough. Two patients with the most serious outcome were aged 90 and 92 years. RSH complicating LMWH therapy appears to constitute a clinical syndrome consisting of sudden onset of abdominal pain in the setting of renal insufficiency, advanced age and abdominal straining (e.g. cough). Risk of RSH may be reduced in patients receiving LMWH by assessing renal function, monitoring heparin levels (e.g. when the creatinine clearance is 40 ml/min or less) and adjusting the dose accordingly; by avoidance of abdominal strain (e.g. by treating cough); and by attention to technique when the abdominal wall is used as the injection site. Patients of advanced age may be at particular risk for RSH.

Rectus Sheath Hematoma: A Series of Unfortunate Events

Rectus sheath hematoma is rare. It can present to physicians in many specialties, but invariably the surgeon is contacted regarding management. It is frequently difficult to diagnose, which can result in delay of treatment or unnecessary surgery. Its incidence is on the rise. We present a series of four cases of rectus sheath hematoma that presented to our hospital within a 5-month period. A comprehensive up-to-date review of the literature was undertaken. Our research highlights the diagnostic dilemmas, the spectrum of severity (all three grades are represented), the complications, and the need for interdisciplinary awareness. Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. Interdisciplinary awareness of this condition is essential, as it is frequently difficult to diagnose, leading to delay in treatment or unneeded surgery. Grade 3 hematomas can lead to abdominal compartment syndrome and can be fatal.

Rectus sheath haematoma requiring laparotomy

Rectus sheath haematoma is a well‐documented but unusual cause of acute abdomen. Combination of clinical features and appropriate radiological investigations can make for a prompt diagnosis. Most authors advocate conservative management and it has been reported that patients were directly discharged from the emergency department. We report a case of rectus sheath haematoma which progressed with clinical deterioration and necessitated surgical intervention for clot evacuation. Causes, physical signs, radiological features and classification of rectus sheath haematoma are discussed. It may be necessary to continue close clinical monitoring after diagnosis of rectus sheath haematoma.

Formation of rectus sheath hematoma with antibiotic use and warfarin therapy: A case report

This case is reported to inform physicians of a case of amoxicillin/clavulanate potassium use in a patient taking warfarin and the subsequent alteration (prolongation) in the international normalized ratio (INR) that resulted in the formation of a rectus sheath hematoma (RSH). A 75-year-old man receiving long-term warfarin therapy developed a lower respiratory tract infection with paroxysmal coughing that was treated with oral amoxicillin 250 mg/clavulanate potassium 125 mg TID for 7 days. In the 3 days after completing antibiotic treatment, he developed increasingly severe lower abdominal pain that was clinically diagnosed as RSH. The patient was admitted to the local hospital for confirmation of the diagnosis and appropriate management. Before this episode, his INR was consistently within therapeutic range (2-3); on admission it had risen to 5.7. His condition was managed conservatively, and he was discharged home 6 days postadmission. This case is reported to highlight the potential interaction between warfarin and amoxicillin/clavulanate potassium and subsequent RSH formation. The potential mechanism of the interaction between amoxicillin/clavulanate potassium and warfarin may be either pharmacokinetic (via metabolism in the cytochrome P4S0 system and preferential metabolism of clavulanate potassium in the liver) or pharmacodynamic (via interference with the production of vitamin K-dependent clotting factors II, VI, IX, and X). This case of RSH in an elderly patient receiving long-term stable warfarin anticoagulation is probably associated with amoxicillin/clavulanate potassium use and paroxysmal coughing.

Mushroom cloud appearance of hemorrhage into the superficial anterior abdominal wall associated with an underlying rectus sheath hematoma

We present a case of rectus sheath hematoma compounded by anterior abdominal wall haemorrhage. Its clinical and anatomical relationship is discussed.

Rectus Sheath Hematoma During Pregnancy - A Severe but Easily Overlooked Condition: A Case Report

Summary Objective Rectus sheath hematoma (RSH) of the abdominal wall is a severe condition caused by a tear in the inferior epigastric artery. Due to its relative rarity compared with other obstetric complications, the early recognition of RSH challenges the diagnostic acumen of obstetricians. We report a case of RSH that was initially suspected to be placenta percreta with bleeding into an extrauterine compartment. The differential diagnosis and management of this clinical condition are also discussed. Case Report A 30-year-old woman, gravida 2 para 1, with a 31-week singleton pregnancy, complained of lower abdominal pain after a week of coughing. Abdominal ultrasonography identified a well-defined, hypoechoic mass with some internal echoes in the right lower quadrant of the abdomen. Doppler sonography detected vascularity with blood flowing around the mass but little within it. The patient underwent cesarean section and exploratory laparotomy because of unstable hemodynamics. After delivery of a 1,680 g male baby, surgical repair of the torn epigastric artery and ruptured rectus abdominis, and sufficient blood transfusion stabilized her condition. Conclusion RSH should be included in the differential diagnosis of patients with abdominal pain during pregnancy. The key to diagnosis is to suspect that the pain originates from the abdominal wall.

Rectus Sheath Haematoma Mimicking An Ovarian Mass

Rectus sheath haematoma (RSH) is an unusual cause of a painful abdominal mass. We report a case of rectus sheath haematoma that was referred to KK Women's and Children's Hospital, Singapore because initial radiological investigations suggested an ovarian tumour.

Rectus sheath hematoma presenting as a gradually enlarging abdominal mass

We report two unusual cases of rectus sheath hematoma. This condition usually presents with acute onset and is generally treated through the general surgery or emergency service department. However, if the hematoma grows slowly it may be diagnosed as an abdominal tumor and the patient may then be referred to the plastic surgery department.

Acute dyspnea in a woman with swelling of the left leg treated with low molecular weight heparine

A case of rectus sheath hematoma diagnosed initially as probable pulmonary embolism in a patient on anticoagulation with low molecular weight heparins for swelling of the left leg is presented. Prompt consideration of this hematoma in the emergency department is important to avoid unnecessary and potentially dangerous treatment.