Rectus sheath hematoma manifesting as hemorrhagic shock

Ramos, Glenda Maria Delgado; Ramos, Lorena Flor; Freire, Amado X.

doi:10.1007/s11739-018-1936-5

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Considered as a complication of patients who receive anticoagulants, unfractioned and low-molecular-weight heparins (LMWH) and/or antiplatelet therapies and as a relatively rare cause of acute abdominal pain, this clinical condition can usually be self-limiting when conservative treatment methods are used [2, 3]. However, SRSH can sometimes progress fast and reach life-threatening magnitudes and may even result in hemorrhagic shock and death due to massive bleeding [4, 5]. Its major risk factors include female gender, advanced age, hypertension, atherosclerosis, hematologic diseases, collagen vascular disorders, degenerative muscle diseases, intra-abdominal injections, paracentesis, peritoneal catheter insertion, pregnancy, obesity, blunt trauma, abdominal surgery, excess-uncontrolled exercising, and increased abdominal pressure from cough or sneeze [6].…”

Section: Introductionmentioning

confidence: 99%

Conservative Treatment of Spontaneous Rectus Sheath Hematomas: Single Center Experience and Literature Review

Karapolat

TAŞDELEN

Korkmaz

2019

Emergency Medicine International

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Introduction. Spontaneous rectus sheath hematoma (SRSH) is characterized by bleeding within the rectus abdominis muscle sheath, one of the rare causes of acute abdominal pain. Early diagnosis is imperative in SRSH to prevent complications and the treatment is usually conservative. We intended to present in this study our experience with SRSH patients with respect to diagnostic evaluation and management of their disease. Materials and Methods. In this retrospective study, 14 patients who had received treatment for SRSH in our clinic between January 2012 and December 2017 were assessed in terms of demographic and clinical characteristics, comorbidities, laboratory parameters, diagnostic approach methods, treatment practices, length of hospital stay, and patient outcomes. Results. The patients consisted of 10 (71.4%) females and 4 males (28.6%). The age of the patients ranged between 47 and 93 with a mean age of 66.5 ± 12.1. Anticoagulant treatments were being administered to 5 (35.7%) patients, antiplatelet treatments to 4 (28.5%) patients, and both anticoagulant and antiplatelet treatments to 4 (28.5%) patients. The most common triggering factor was severe cough and the most common initial symptom acute abdominal pain (71.4%). In physical examinations, the entire patients had generalized abdominal tenderness, 10 (71.4%) voluntary guarding and 7 (50%) a right lower quadrant mass. The diagnosis was confirmed by abdominal ultrasonography and computed tomography. Based on the computed tomography findings, the disease was classified as Type 2 found in 9 (64.3%) patients, Type 1 in 3 (21.4%) patients, and Type 3 in 2 (14.2%) patients. All the patients were treated conservatively. They were hospitalized for 1 to 23 days. There was no mortality. All the patients were followed up between 3 months and 2 years and no recurrence was recorded. Conclusion. Considering the presence of SRSH particularly in older female patients who use anticoagulant drugs and have newly developed an abdominal pain and a palpable mass after coughing spells is the key to make an early and correct diagnosis and to prevent possible morbidity and mortality with an appropriate treatment method.

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Section: Introductionmentioning

confidence: 99%

Conservative Treatment of Spontaneous Rectus Sheath Hematomas: Single Center Experience and Literature Review

Karapolat

TAŞDELEN

Korkmaz

2019

Emergency Medicine International

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“…Rectus sheath hematoma may occur from not only a direct blow, but also strenuous non-contact exercise and trivial movements like twisting or sudden muscle strain and change in position without direct trauma. It occurs due to rupture of the upper and lower epigastric arteries and their branches or rupture of the rectus muscles themselves during contraction [13]. In our patient, we assume that the forceful contraction of the rectus muscles during exercise may have caused tearing of the epigastric vessel branches and led to rectus sheath bleeding.…”

Section: Discussionmentioning

confidence: 86%

Case of Nontraumatic Rectus Sheath Hematoma from Muscle Training Mimicking Acute Abdomen

Ariyoshi

Naito

Ihoriya

et al. 2019

Case Reports in Emergency Medicine

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Rectus sheath hematoma is an unusual but well-known clinical problem. Our hospital admitted a 54-year-old woman complaining of harsh right-sided hypogastric pain that started while muscle training. Computed tomography of the abdomen and pelvis demonstrated a right rectus sheath hematoma. As the hematoma did not increase, the patient was conservatively treated. Despite increased awareness of rectus sheath hematoma, its early diagnosis and treatment still present a challenge to emergency physicians. Swift acknowledgement of this rare cause of abdominal pain may avoid more intrusive examination, unnecessary hospitalization, and laparotomy. Careful consideration of the patient’s medical history and a high index of suspicion are needed to diagnose this complication.

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“…Conservative approach in most cases is sufficient and the condition is self limited (Figures 3,4 and 5). If the conservative approach fails vascular embolization or surgical repair is indicated [1][2][3].…”

Section: Her Postoperative Course Was Uneventfulmentioning

confidence: 99%