Spontaneous Rectus Sheath Hematoma: An Uncommon Cause of Acute Abdominal Pain

Conservative Treatment for Spontaneous Rectus Sheath Hematoma: A Case Report

Rectus sheath hematoma is a rare but clinically important cause of acute abdominal pain. In most cases, patients have a history of trauma or are taking antiplatelet or anticoagulant therapy. Spontaneous rectus sheath hematoma is even rarer, with atheromatous changes identified as a contributing factor in the elderly. A 100-year-old woman with a history of hypertension, chronic obstructive pulmonary disease, and congestive heart failure presented to our emergency department with sudden-onset abdominal pain and a large lower abdominal mass. She was not on anticoagulant treatment and denied any traumatic event or excessive strain on abdominal musculature such as a cough. A CT scan showed a hematoma involving the left anterior abdominal wall at the rectus sheath, extending into the lower abdomen. Subsequently, she was diagnosed with spontaneous rectus sheath hematoma. We started conservative treatment with hemostatic agents, namely, carbazochrome and tranexamic acid to control the expansion of bleeding. Her hemoglobin level and vital signs remained stable, and her symptoms improved significantly. A follow-up CT scan four days after admission revealed a reduction in the size of the hematoma. The patient's treatment course was uncomplicated, and she was eventually discharged on the sixth day of her admission. Rectus sheath hematoma is associated with a high morbidity and mortality rate in patients, especially those with additional comorbidities. Early diagnosis and sufficient supportive treatment are crucial for management. We suggest that carbazochrome and tranexamic acid are also effective therapies.

Rectus sheath hematoma combined with COVID-19: A case report

BACKGROUND

Rectus sheath hematoma (RSH) is uncommon, and because people have limited knowledge about it, it is difficult to recognize the symptoms in time, often de-laying optimal treatment.

CASE SUMMARY

Herein, we report a case of a 77-year-old female with RSH. The patient was treated at our hospital for coronavirus disease 2019. Anticoagulant treatment was administered during this period because of thrombosis. On the 8th d of treatment, the patient complained of abdominal pain. Ultrasonography revealed a solid cystic mass in the pelvic cavity. An emergency laparotomy was performed, and a huge hematoma was found in the deep layer of the rectus abdominis muscle. We used anticoagulants with caution based on the patient's condition.

CONCLUSION

Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.

A case of rectus sheath hematoma in the setting of paroxysmal coughing and platelet dysfunction

Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that may mimic other intra-abdominal pathologies. It is caused by the rupture of the superior or inferior epigastric artery or vein in the rectus abdominis muscle. Clinical features include sudden-onset abdominal pain and a palpable mass, and common risk factors include anti-coagulants, platelet dysfunction, and cough. Workup includes a physical exam, complete blood count, coagulation profile, ultrasound, and computed tomography. While most cases are treated conservatively, uncontrolled hemorrhage may be lethal and requires prompt recognition. We discuss a case of RSH which developed in the setting of paroxysmal coughing and platelet dysfunction. The purpose is to highlight the diagnosis and treatment of RSH and emphasize the importance of its inclusion in the differential for acute abdominal pain.

A rare case report: Spontaneous rectus sheath and iliopsoas hematomas: Clinical presentation, management, and implications

INTRODUCTION AND IMPORTANCE

Frequently misdiagnosed, the clinical condition of soft tissue hematoma typically emerges following blunt abdominal trauma and/or anticoagulant medication usage, with spontaneous occurrences being infrequent. In this case report, we present a spontaneous rectus sheath and iliopsoas hematomas without obvious classical risk factors. The purpose of presenting this case is to bring attention to this unusual clinical condition and emphasize the role of thorough history and physical examination in determining the suitable course of treatment.

CASE REPORT

A 50-year-old woman with no medical history presented at the emergency room due to sudden asthenia and abdominal pain. Physical examination revealed a painful 20 cm hypogastric mass and left lumbar swelling causing leg bending. Lab tests indicated anemia and normal coagulation. CT scans showed significant hematomas in the left rectus and psoas muscles. Intensive monitoring and supportive measures stabilized her condition without resorting to surgery.

CLINICAL DISCUSSION

Soft tissue hematomas, notably in the rectus sheath or iliopsoas muscle, are rare but potentially severe conditions. Their pathophysiology is not fully understood, and risk factors include age, anticoagulant use, and comorbidities. Diagnosis involves abdominal examination, anemia, and CT findings. Management varies based on symptom severity and blood loss, ranging from conservative approaches to surgery or embolization.

CONCLUSION

Swift identification and effective handling of soft tissue hematomas hold utmost importance. The thorough history-taking and comprehensive physical examination play pivotal roles within this protocol. While supportive care constitutes the primary mode of management, instances arise where surgical intervention or vascular embolization becomes imperative for hematomas unresponsive to treatment and presenting hemodynamic instability.