Is conservative management of spontaneous rectus sheath hematoma effective?

Kaya, Cemal; İdiz, Ufuk Oğuz; Yazici, Pınar; Bozkurt, Emre; Ömeroğlu, Sinan; Unlu, Mehmet Taner; Mihmanlı, Mehmet

doi:10.5350/semb.20161028021723

Cited by 3 publications

(6 citation statements)

References 15 publications

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“…Therefore, the study considers that there is no relationship between the duration of treatment and bleeding in patients with COVID-19. Although abdominal pain is the most common symptom described in the literature in patients with RSH, there is no specific symptom that directs the clinician to the diagnosis of RSH [ 19 , 20 , 22 ]. Therefore, the diagnosis of RSH is mostly made using imaging methods.…”

Section: Discussionmentioning

confidence: 99%

Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings

Emekli¹,

Yıldırım²,

Türkkanı³

et al. 2023

Cureus

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Objectives This study aims to investigate the frequency of rectus sheath hematoma (RSH), clinical findings, imaging findings, and prognosis in patients admitted to the hospital due to COVID-19. Methods In this retrospective study, the patient's demographic characteristics, known diseases, laboratory values, RSH-related symptoms, the treatment they received, imaging modality used to diagnose RSH, and side and size of RSH were recorded. In addition, the inpatient ward to which the patients were admitted, length of hospital stay, time from the beginning of anticoagulant use to the diagnosis of RSH, and prognosis were noted. Results A total of 9,876 patients were admitted to the hospital due to COVID-19 and started anticoagulant treatment. Of these patients, 12 (0.12%) were determined to have RSH (female/male ratio: 5). The prothrombin time, activated partial thromboplastin time, international normalized ratio, hemoglobin, and hematocrit values of 11 patients were within the reference ranges. The mean length of hospital stay was 12 (4.25-22.5) days, and the duration of anticoagulant use was 5.5 (4-10.75) days. RSH was diagnosed using USG in 10 patients and CT in two patients. Conclusion There has been an increase in the use of anticoagulants due to COVID-19, and accordingly, RSH is now more frequently diagnosed and has a more fatal course. Female gender, advanced age, severe COVID-19 disease, and elevated d-dimer at the time of presentation can be considered risk factors for the development of RSH. All physicians who treat and follow up on patients with COVID-19 should consider the possibility of RSH in the differential diagnosis of patients with acute abdominal pain and palpable masses. USG should be undertaken as the first-line imaging modality for the diagnosis of patients, but CT may also be necessary to detect RSH in some cases.

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Section: Discussionmentioning

confidence: 99%

Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings

Emekli¹,

Yıldırım²,

Türkkanı³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…After the discontinuation of anticoagulant and antithrombotic therapies, it is recommended that coagulation disorders be corrected with Vitamin K, FFP, and protamine sulfate; blood replacement is also recommended. [ 7 , 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Rectus sheath hematoma (RSH) is a rare clinical condition that is most prevalent in elderly patients who are prone to bleeding. [ 7 ] The most common cause of RSH is the use of anticoagulant therapy. LMWH, which is one of the options of anticoagulant therapy, is routinely used to prevent arterial and venous thrombotic events in patients diagnosed with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Kalaycı¹

2022

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anticoagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up. METHODS: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups. RESULTS: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group. CONCLUSION: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.

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“…After discontinuation of anticoagulant and antithrombotic therapies, it is recommended that coagulation disorders have to be corrected with vitamin K, FFP and protamine sulfate and also blood replacement is recommended for these patients. [8,9] In our study, blood transfusion (6 units of RBC) was performed in three patients (9.6%) who underwent surgery with hemodynamic instability and increased hematoma size. Totally 14 units (median 2.3 units) of RBC were administered to six patients (19.3%).…”

Section: Discussionmentioning

confidence: 99%

“…The cases with a performed abdominal imaging data were staged according to Berná et al's [7] classification by the properties of the extension of the hematoma (Table 1). [8] Type 2-3 patients with severe comorbidities, unstable clinical parameters and hemodynamic values were followed in the general surgical intensive care unit.…”

Section: Methodsmentioning

confidence: 99%

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

İliklerden

Kalaycı

2021

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management. METHODS:Patients who underwent treatment with the diagnosis of rectus sheath hematoma between May 2010 and July 2018 were retrospectively analyzed. Demographic characteristics, medical histories, physical and laboratory findings and imaging methods, treatment processes, complications, morbidity, mortality, length of hospitalization and long-term follow-up results were searched. Data were analyzed from patient files, hospital computer registry system and radiology archives. Data analysis was performed using Microsoft Excel and IBM-SPSS-Statistics-24. RESULTS:The mean age of the 31 patients was 63.03 years (24-85 years). The female/male ratio (21/10) was 2.1. The most common presenting sign or symptom was abdominal pain (100%), followed by abdominal wall mass in 25 patients (80.6%). Twenty-five patients (80.6%) were receiving some form of anticoagulation and antiplatelet therapy. Diagnosis was confirmed by Computed Tomography in 11 (45.4%), Ultrasonography in five (16.1%) and Computed Tomography with Ultrasonography in 15 (33.3%). Eight patients (25.8%) were evaluated as Type-1, 10 (32.2%) as Type-2 and 13 (41.9%) as Type-3. Mean International Normalized Ratio (INR) value of patients was 2.59. Bleeding was controlled by surgery in three cases (9.6%). The conservative approach was preferred in 28 cases (90.3%). 29 (93.5%) patients were discharged after an average hospital stay of 7.48 days (4-21). One patient died on the postoperative 5th day and other on the 14 th day of conservative treatment (6.45% mortality). The mortality rate of conservatively and surgically treated patients was 3.5% and 33.3%, respectively. CONCLUSION:Rectus sheath hematoma should be suspected in elderly patients using anticoagulants with acute abdominal pain, severe cough attacks and an umbilical palpable or radiologically supported mass. Computed Tomography and Ultrasonography should be performed in case of clinical suspicion. Early and correct diagnosis ensures successful conservative treatment and prevents unneces-sary surgical procedures. In the management of cases where clinician experience is at the forefront, we are hopeful that a new effective algorithm system and guidelines for the diagnosis will be identified after increasing the presentations of case series and experiences.

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Is conservative management of spontaneous rectus sheath hematoma effective?

Cited by 3 publications

References 15 publications

Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings

Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

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