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

Abstract

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.

Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy: A Case Report

“…The possible risk of using such devices in patients with severe COVID-19 who are on anticoagulant therapy must be considered, as these patients have a high incidence of major bleeding [ 10 ], including spontaneous RSHs [ 4 ]. Indeed, the retrospective study by Emekli et al [ 3 ] of 9,876 hospitalized COVID-19 patients receiving anticoagulants identified 0.12% (12 patients) who developed RSHs, with anticoagulant use ranging from 4 to 10.75 days at therapeutic doses. Symptoms leading to an RSH diagnosis included abdominal pain, sudden drops in Hgb, palpable mass, and ecchymosis.…”

“…Extrinsic factors encompass a wide range of conditions, such as pelvic and retroperitoneal tumors, benign prostatic hyperplasia, and vascular and inflammatory diseases. Cases of obstructive uropathy due to rectus sheath hematoma (RSH) [ 1 , 2 ] and RSH in patients hospitalized with COVID-19 [ 3 , 4 ] have been documented, but we present a unique case of a patient admitted with COVID-19 acute respiratory syndrome exhibiting both conditions concurrently.…”