Conservative management of a progressively growing rectus sheath hematoma presented in a patient with chronic renal failure: A case report

Abstract

Introduction: Rectus sheath hematoma is a rare but an important clinical entity in the differential diagnosis of abdominal pain. It is often a self-limiting condition that can be managed successfully in conservative measures. If not recognized, it can lead to unnecessary emergency surgical procedures. A 55-year-old male patient suffering from chronic renal failure and cardiomyopathy presented with a progressively growing abdominal mass diagnosed to be a bilateral rectus sheath hematoma. Despite many complications related to alteration of general status, electrolyte imbalance and coagulation problems, conservative management proved successful, while prompt surgical intervention could have ended in death in such a fragile patient.

A Proposed Algorithm on the Modern Management of Rectus Sheath Hematoma: A Literature Review

“…When the patient is hemodynamically stable, conservative management of RSH has been found to be the most effective treatment methodology due to the self-limiting nature of RSH [ 4 , 11 , 20 ]. Approximately 56-83% of the patients studied are successfully managed with CM alone [ 1 , 8 , 13 , 18 , 20 ].…”

“…In a historical study, hematoma size has been suggested as a prognostic factor for surgery. RSH < 5 cm in diameter can be managed with CM while large RSH > 5 cm in diameters are managed with surgical intervention [ 4 , 13 ]. In the historical Klingler et al study, eight out of 23 patients had large RSH while 15 patients had small RSH.…”

“…Risk factors for RSH include anticoagulation treatment, paroxysmal coughing, hypertension, advanced age, and previous abdominal surgery [2,3]. Current first-line treatment for RSH is conservative management (CM) involving fluids resuscitation, blood replacement, reversal of anticoagulation, lab monitoring, and bed rest [2,4]. However, when CM fails, further surgical or embolization interventions are available and may be necessary.…”

“…Current first-line treatment for RSH is conservative management (CM) involving fluids resuscitation, blood replacement, reversal of anticoagulation, lab monitoring, and bed rest [ 2 , 4 ]. However, when CM fails, further surgical or embolization interventions are available and may be necessary.…”