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.
Similar content being viewed by others
References
Casey RG, Mahmoud M, Hurley M, et al. Rectus sheath hematoma: an unusual diagnosis. Ir Med J 2000;93:90–92
Teske JM. Hematoma of the rectus abdominis muscle: report of a case and analysis of 100 cases from the literature. Am J Surg 1946;71:689–695
Decker R, Buhr H, Gahbauer H. Acute rectus sheath hematoma (differential diagnosis of acute abdomen). Chirurg 1986;57:401–405
Werdehoff SG, Blomkalns AL. Rectus sheath hematoma. On eMedicine January 2005
Jayawardene S, Goldsmith D. Clinical picture: rectus sheath hematoma. Lancet 2001;358:1409
Holmes SJ. Rectus sheath hematoma as a cause of acute abdominal pain. Am Fam Physician 2001;64:1681–1682
Cavagna E, Carubia G, Schiavon F. Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles. Radiol Med (Torino) 2000;99:432–437
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;13:1129–1134
Monsein LH, Davies M. Radionuclide imaging of a rectus sheath hematoma caused by insulin injections. Clin Nucl Med 1990;15:539–541
Humphrey R, Carlan SJ, Greenbaum L. Rectus sheath hematoma in pregnancy. J Clin Ultrasound 2001;29:306–311
Jayavardene SA, Goldsmith DJA. Rectus sheath hematomata in patients with renal disease. Nephrol Dial Transplant 2002;17:1832–1835
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;103:332–333
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;64:251–257
Ergün N, Cevik AA, Holliman CJ, et al. Conservative management of giant abdominal wall hematoma. Ulus Trauma Derg 2004;10:141–144
Fothergill WE. Hematoma in the abdominal wall simulating pelvic new growth. BMJ 1926;1:941–942
Thia EWH, Low JJH, Wee HY. Rectus sheath hematoma mimicking an ovarian mass. Internet J Gynaecol Obstet 2003;2(1)
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;84:1295–1297
Fukuda T, Sakamoto I, Kohzaki S, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 1996;21:58–61
Cervantes J, Sanchez-Cortazar J, Ponte RJ, et al. Ultrasound diagnosis of rectus sheath hematoma. Am Surg 1983;49:542–545
Berna JD, Garcia-Medina V, Guirao J, et al. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 1996;1:62–4
Park SH, Oh DR, Kim HK, et al. Spontaneous rectus sheath hematoma with hypovolaemic shock. J Korean Soc Emerg Med 2000;11:586–591
Askew AR. Rectus sheath hematoma causing muscle necrosis. Aust N Z J Surg 1980;50:531–532
Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma. JAMA 1983;249:924–925
O’Mara MS, Semins H, Hathaway D, et al. Abdominal compartment syndrome as a consequence of rectus sheath hematoma. Am Surg 2003;69:975–977
Mohapatra B. Abdominal compartment syndrome. Indian J Crit Care Med 2004;8:26–32
Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997;174:667–672
Shabani AGS, Baxter GM. Inferior epigastric artery pseudo aneurysm: ultrasound diagnosis and treatment with percutaneous thrombin. Br J Radiol 2002;75:689–691
Levy JM, Gordon HW, Pitha NR, et al. Gelfoam embolisation for control of bleeding from rectus sheath hematoma. AJR Am J Roentgenol 1980;135:1283–1284
Zack JR, Ferral H, Postoak D, et al. Coil embolization of rectus sheath hemorrhage. J Trauma 2001;51:793–795
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Luhmann, A., Williams, E. Rectus Sheath Hematoma: A Series of Unfortunate Events. World J. Surg. 30, 2050–2055 (2006). https://doi.org/10.1007/s00268-005-0702-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-0702-9