Arteriovenous malformation: An unusual cause of rectus sheath hematoma, following laparoscopic cholecystectomy

Abstract

Rectus sheath hematoma (RSH) is an accumulation of blood in the rectus abdominis muscle sheath, secondary to several conditions which may cause the epigastric vessel rupture or muscular tear, but mostly affecting patients undergoing anticoagulation therapy.We present a rare case of a 67-year-old woman who underwent laparoscopic cholecystectomy and developed RSH on the 12th postoperative day. The patient was under anticoagulation therapy with acenocoumarole due to mitral valve replacement. The bleeding source was an arteriovenous malformation (AVM) rupture as indicated by the angiogram images and it was embolized succefully. The patient was discharged seven days later.

Spontaneous rectus sheath hematoma associated with apixaban in an elderly gentleman with chronic obstructive airway disease – a case report

“…In addition, atheromatous changes in epigastric venules have been identified as a contributing factor for spontaneous RSH in elderly [ 5 ]. Although vascular malformation has been reported as a rare cause for RSH and was not completely excluded in our patient by angiography [ 8 ], we believe that intense coughing bouts due to COAD exacerbation in an elderly patient in the presence of apixaban were adequate trigger for the incident RSH. In addition, invasive angiography, which is usually reserved for arterial embolization in hemodynamically compromised patients, was not considered in our patient whose RSH occurred singly and was managed successfully with a conservative approach.…”

Post-caesarean Rectus Sheath Haematoma

“…Causes of RSH includes abdominal surgery, blunt trauma, subcutaneous drug injection, coughing, trocar site injury after laparoscopic procedure, physical exercise, pregnancy, hematological diseases and spontaneously in patient undergoing anticoagulation treatment. 2 They are usually located infraumbilically and almost never crosses the midline and often misdiagnosed as DFXWH DEGRPHQ LQÀDPPDWRU\ GLVHDVH RU WXPRU RI abdomen. Haematoma below the lineasemicircularis causes an indirect irritation on the peritoneum due to weak posterior rectus sheath in this region leading to misdiagnosis as acute abdomen.…”