Skip to main content
Log in

Rectus Sheath Hematoma: A Series of Unfortunate Events

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1.
Figure 2.
Figure 3.

Similar content being viewed by others

References

  1. Casey RG, Mahmoud M, Hurley M, et al. Rectus sheath hematoma: an unusual diagnosis. Ir Med J 2000;93:90–92

    PubMed  CAS  Google Scholar 

  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;71:689–695

    Article  Google Scholar 

  3. Decker R, Buhr H, Gahbauer H. Acute rectus sheath hematoma (differential diagnosis of acute abdomen). Chirurg 1986;57:401–405

    PubMed  CAS  Google Scholar 

  4. Werdehoff SG, Blomkalns AL. Rectus sheath hematoma. On eMedicine January 2005

  5. Jayawardene S, Goldsmith D. Clinical picture: rectus sheath hematoma. Lancet 2001;358:1409

    Article  Google Scholar 

  6. Holmes SJ. Rectus sheath hematoma as a cause of acute abdominal pain. Am Fam Physician 2001;64:1681–1682

    PubMed  CAS  Google Scholar 

  7. Cavagna E, Carubia G, Schiavon F. Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles. Radiol Med (Torino) 2000;99:432–437

    CAS  Google Scholar 

  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;13:1129–1134

    Article  PubMed  CAS  Google Scholar 

  9. Monsein LH, Davies M. Radionuclide imaging of a rectus sheath hematoma caused by insulin injections. Clin Nucl Med 1990;15:539–541

    Article  PubMed  CAS  Google Scholar 

  10. Humphrey R, Carlan SJ, Greenbaum L. Rectus sheath hematoma in pregnancy. J Clin Ultrasound 2001;29:306–311

    Article  PubMed  CAS  Google Scholar 

  11. Jayavardene SA, Goldsmith DJA. Rectus sheath hematomata in patients with renal disease. Nephrol Dial Transplant 2002;17:1832–1835

    Article  Google Scholar 

  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;103:332–333

    PubMed  CAS  Google Scholar 

  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;64:251–257

    Google Scholar 

  14. Ergün N, Cevik AA, Holliman CJ, et al. Conservative management of giant abdominal wall hematoma. Ulus Trauma Derg 2004;10:141–144

    Google Scholar 

  15. Fothergill WE. Hematoma in the abdominal wall simulating pelvic new growth. BMJ 1926;1:941–942

    Article  Google Scholar 

  16. Thia EWH, Low JJH, Wee HY. Rectus sheath hematoma mimicking an ovarian mass. Internet J Gynaecol Obstet 2003;2(1)

  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;84:1295–1297

    Article  PubMed  CAS  Google Scholar 

  18. Fukuda T, Sakamoto I, Kohzaki S, et al. Spontaneous rectus sheath hematomas: clinical and radiological features. Abdom Imaging 1996;21:58–61

    Article  PubMed  CAS  Google Scholar 

  19. Cervantes J, Sanchez-Cortazar J, Ponte RJ, et al. Ultrasound diagnosis of rectus sheath hematoma. Am Surg 1983;49:542–545

    PubMed  CAS  Google Scholar 

  20. Berna JD, Garcia-Medina V, Guirao J, et al. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging 1996;1:62–4

    Google Scholar 

  21. Park SH, Oh DR, Kim HK, et al. Spontaneous rectus sheath hematoma with hypovolaemic shock. J Korean Soc Emerg Med 2000;11:586–591

    Google Scholar 

  22. Askew AR. Rectus sheath hematoma causing muscle necrosis. Aust N Z J Surg 1980;50:531–532

    PubMed  CAS  Google Scholar 

  23. Ducatman BS, Ludwig J, Hurt RD. Fatal rectus sheath hematoma. JAMA 1983;249:924–925

    Article  PubMed  CAS  Google Scholar 

  24. O’Mara MS, Semins H, Hathaway D, et al. Abdominal compartment syndrome as a consequence of rectus sheath hematoma. Am Surg 2003;69:975–977

    PubMed  Google Scholar 

  25. Mohapatra B. Abdominal compartment syndrome. Indian J Crit Care Med 2004;8:26–32

    Google Scholar 

  26. Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997;174:667–672

    Article  PubMed  CAS  Google Scholar 

  27. Shabani AGS, Baxter GM. Inferior epigastric artery pseudo aneurysm: ultrasound diagnosis and treatment with percutaneous thrombin. Br J Radiol 2002;75:689–691

    PubMed  CAS  Google Scholar 

  28. Levy JM, Gordon HW, Pitha NR, et al. Gelfoam embolisation for control of bleeding from rectus sheath hematoma. AJR Am J Roentgenol 1980;135:1283–1284

    PubMed  CAS  Google Scholar 

  29. Zack JR, Ferral H, Postoak D, et al. Coil embolization of rectus sheath hemorrhage. J Trauma 2001;51:793–795

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andreas Luhmann MRCS.

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0702-9

Keywords

Navigation