Rectus Sheath Haematoma: A Rare Cause of Abdominal Pain

• Published in: Hong Kong journal of emergency medicine Vol. 18; no. 3; pp. 161 - 165
• Main Authors: Akay, S, Caliskan, C, Gonullu, H, Dal, O, Korkut, MA, Erkan, N
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-05-2011
• Subjects: Abdominal muscle; Abdominal pain; Acute abdomen; anticoagulant; Diagnosis; Emergency medical services; haemorrhages; Hematoma; rectus abdominis; spontaneous rupture; Warfarin; China; rectus abdominis; anticoagulant; spontaneous rupture; Abdominal muscle; haemorrhages
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/102490791101800306

Objective
Rectus sheath haematoma (RSH) is a rare entity described as accumulation of blood within the rectus muscle. Patients can present with varying symptoms and signs, mimicking acute abdominal conditions. Failure to diagnose can result in unnecessary diagnostic procedures and surgical interventions.
Methods
We presented a series of 14 cases of RSH presenting to two emergency departments (ED) within a period of 3 years. Their demographic characteristics, medical history, presenting signs, symptoms and treatment were analyzed.
Results
Fourteen cases were diagnosed RSH. Seven cases were on warfarin treatment. Three RSH cases were diagnosed by ultrasonography (USG) only while the remainders had additional computed tomography (CT). Two cases had surgery due to haemoperitoneum, and the rest were treated conservatively with bed rest, analgesics and reversal of anticoagulation therapy. All patients were discharged from hospitals.
Conclusions
RSH is an important entity which must be considered in patients with known risk factors presenting to ED with abdominal pain. In elderly patients with a history of cough, anticoagulant use with palpable mass on abdominal wall, RSH must be considered as a possible diagnosis for unexplained abdominal pain. USG, together with CT in selected cases, should be performed to reveal this rare disease entity.