World Journal of Surgery

, Volume 30, Issue 11, pp 2050–2055

Rectus Sheath Hematoma: A Series of Unfortunate Events

Article

Abstract

Introduction

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.

Methods

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.

Results

Our research highlights the diagnostic dilemmas, the spectrum of severity (all three grades are represented), the complications, and the need for interdisciplinary awareness.

Conclusions

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.

References

  1. 1.
    Casey RG, Mahmoud M, Hurley M, et al. Rectus sheath hematoma: an unusual diagnosis. Ir Med J 2000;93:90–92PubMedGoogle Scholar
  2. 2.
    Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature. Am J Surg 1946;71:689–695CrossRefGoogle Scholar
  3. 3.
    Decker R, Buhr H, Gahbauer H. Acute rectus sheath hematoma (differential diagnosis of acute abdomen). Chirurg 1986;57:401–405PubMedGoogle Scholar
  4. 4.
    Werdehoff SG, Blomkalns AL. Rectus sheath hematoma. On eMedicine January 2005Google Scholar
  5. 5.
    Jayawardene S, Goldsmith D. Clinical picture: rectus sheath hematoma. Lancet 2001;358:1409CrossRefGoogle Scholar
  6. 6.
    Holmes SJ. Rectus sheath hematoma as a cause of acute abdominal pain. Am Fam Physician 2001;64:1681–1682PubMedGoogle Scholar
  7. 7.
    Cavagna E, Carubia G, Schiavon F. Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles. Radiol Med (Torino) 2000;99:432–437Google Scholar
  8. 8.
    Klingler PJ, Wetscher G, Glaser K, et al. The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders. Surg Endosc 1999;13:1129–1134PubMedCrossRefGoogle Scholar
  9. 9.
    Monsein LH, Davies M. Radionuclide imaging of a rectus sheath hematoma caused by insulin injections. Clin Nucl Med 1990;15:539–541PubMedCrossRefGoogle Scholar
  10. 10.
    Humphrey R, Carlan SJ, Greenbaum L. Rectus sheath hematoma in pregnancy. J Clin Ultrasound 2001;29:306–311PubMedCrossRefGoogle Scholar
  11. 11.
    Jayavardene SA, Goldsmith DJA. Rectus sheath hematomata in patients with renal disease. Nephrol Dial Transplant 2002;17:1832–1835CrossRefGoogle Scholar
  12. 12.
    Ozaras R, Yilmaz MH, Tahan V, et al. Spontaneous hematoma of the rectus abdominis muscle: a rare cause of acute abdominal pain in the elderly. Acta Chir Belg 2003;103:332–333PubMedGoogle Scholar
  13. 13.
    Linhares MM, Lopes Filho GJ, Bruna PC, et al. Spontaneous hematoma of the rectus abdominis sheath: a review of 177 cases with report of 7 personal cases. Int Surg 1999;64:251–257Google Scholar
  14. 14.
    Ergün N, Cevik AA, Holliman CJ, et al. Conservative management of giant abdominal wall hematoma. Ulus Trauma Derg 2004;10:141–144Google Scholar
  15. 15.
    Fothergill WE. Hematoma in the abdominal wall simulating pelvic new growth. BMJ 1926;1:941–942CrossRefGoogle Scholar
  16. 16.
    Thia EWH, Low JJH, Wee HY. Rectus sheath hematoma mimicking an ovarian mass. Internet J Gynaecol Obstet 2003;2(1)Google Scholar
  17. 17.
    Moreno Gallego A, Aguayo JL, Flores B, et al. Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath hematomas. Br J Surg 1997;84:1295–1297PubMedCrossRefGoogle Scholar
  18. 18.
    Fukuda T, Sakamoto I, Kohzaki S, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 1996;21:58–61PubMedCrossRefGoogle Scholar
  19. 19.
    Cervantes J, Sanchez-Cortazar J, Ponte RJ, et al. Ultrasound diagnosis of rectus sheath hematoma. Am Surg 1983;49:542–545PubMedGoogle Scholar
  20. 20.
    Berna JD, Garcia-Medina V, Guirao J, et al. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 1996;1:62–4Google Scholar
  21. 21.
    Park SH, Oh DR, Kim HK, et al. Spontaneous rectus sheath hematoma with hypovolaemic shock. J Korean Soc Emerg Med 2000;11:586–591Google Scholar
  22. 22.
    Askew AR. Rectus sheath hematoma causing muscle necrosis. Aust N Z J Surg 1980;50:531–532PubMedGoogle Scholar
  23. 23.
    Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma. JAMA 1983;249:924–925PubMedCrossRefGoogle Scholar
  24. 24.
    O’Mara MS, Semins H, Hathaway D, et al. Abdominal compartment syndrome as a consequence of rectus sheath hematoma. Am Surg 2003;69:975–977PubMedGoogle Scholar
  25. 25.
    Mohapatra B. Abdominal compartment syndrome. Indian J Crit Care Med 2004;8:26–32Google Scholar
  26. 26.
    Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997;174:667–672PubMedCrossRefGoogle Scholar
  27. 27.
    Shabani AGS, Baxter GM. Inferior epigastric artery pseudo aneurysm: ultrasound diagnosis and treatment with percutaneous thrombin. Br J Radiol 2002;75:689–691PubMedGoogle Scholar
  28. 28.
    Levy JM, Gordon HW, Pitha NR, et al. Gelfoam embolisation for control of bleeding from rectus sheath hematoma. AJR Am J Roentgenol 1980;135:1283–1284PubMedGoogle Scholar
  29. 29.
    Zack JR, Ferral H, Postoak D, et al. Coil embolization of rectus sheath hemorrhage. J Trauma 2001;51:793–795PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  1. 1.Royal Glamorgan HospitalYnys MaerdyUK
  2. 2.PenplasUK

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