Endovascular management of rectus abdominis hematoma: A report of two cases

Rectus sheath hematoma

“…Bedside US has an 87% overall sensitivity in the identification of muscle injury and is highly valuable in ruling out other sources of abdominal pathology 1,3. Although US is quick, noninvasive, readily accessible, and inexpensive, its value can be limited by healthcare provider inexperience 2. In contrast, although more time-consuming, CT scans have 100% sensitivity in the accurate diagnosis of RSH and can show the exact origin, extent, and size of the hematoma as well as any active bleeding 2.…”

“…RSH more often occurs below the umbilicus potentially in part because of the larger outer diameter of the inferior epigastric artery (3.4 mm) compared with that of the superior epigastric artery (1.6 mm) 1. Moreover, the absence of the posterior rectus sheath below the arcuate line and weaker support of the rectus abdominis muscle by the transversalis fascia and peritoneum increases the risk of hematoma below the umbilicus 2,3. Hematomas formed by the inferior epigastric arteries are typically less restricted or self-limiting and more prominent 2.…”

“…Extrinsic muscle injury, on the other hand, follows direct, blunt trauma or abdominal surgery (Table 2). 1,2…”

“…2,3 Hematomas formed by the inferior epigastric arteries are typically less restricted or self-limiting and more prominent. 2 İ liklerden and Kalaycı conducted a retrospective study of patients who underwent treatment for RSH between 2010 and 2018 in an ED in Turkey. 5 Th e researchers concluded that 25 of 31 patients developed hematomas in one or both lower abdominal quadrants, reinforcing the increased risk of RSH formation below the umbilicus.…”

“…Rectus sheath hematoma (RSH) is a rare clinical condition caused by the rupture of epigastric vessels or tears in the rectus abdominis muscles, resulting in hematoma 1. RSHs can vary in size and location, can cause acute abdominal pain, and are more commonly observed in adult patients receiving anticoagulants 2. Although RSH is often benign and may be overlooked during an initial physical assessment, this medical condition can result in hemorrhagic shock and death 1.…”