Spontaneous Hematoma of the Rectus Abdominis Muscle: a Rare Cause of Acute Abdominal Pain in the Elderly

Abstract

A rectus abdominis sheath hematoma (RSH) is uncommon. It may mimic other acute abdominal disorders. The underlying conditions are trauma, coagulation disorders, or anticoagulant therapy, complications related to operations, subcutaneous injections to the abdominal wall, although it can also develop spontaneously. Acute abdominal pain and a palpable mass after muscular strain such as coughing, sneezing, and twisting were features highly suggestive of RSH. The diagnostic means of choice is computerized tomography. The treatment is usually conservative, but surgery may be needed in cases with large or progressing hematomas or with severe symptoms. We herein report an elderly woman presenting with an acute painful abdominal mass, without any underlying conditions, which was diagnosed as spontaneous RSH. She needed an operation. We concluded that RSH should be considered in the differential diagnosis of acute abdominal pain in the elderly, even in the absence of underlying conditions.

Spontaneous Rectus Sheath Hematoma: an Overview of 4-Year Single Center Experience

“…With conservative therapy, hematomas are resolved spontaneously [13,14]. Coagulation disorders should also be treated, and the use of anticoagulation should be discontinued [15]. Conservative therapy and treatment of bleeding disorders were successfully applied to eight of our patients (80 %) [10].…”

Spontaneous spleen rupture and rectus sheath hematoma in a patient with Klippel-Trenaunay syndrome: Report of a case

“…Some cases of RSH have more obvious causes, such as an underlying abdominal wall abscess or major trauma. 12,13 Cherry and Mueller reported that the most common etiologic factor for RSH in a series of 126 patients was abdominal surgery, and that RSH developed within the fi rst month after surgery. 11 In our patient, the RSH appeared 40 days after surgery.…”

Spontanoeus Lateral Abdominal Wall Hematoma As A Complication Of Coughing :Case Report And Literature Review

“…Physical examination usually reveals a tender abdominal mass of the lower abdomen. The condition may mimic different abdominal pathologies such as appendicitis, sigmoid diverticulitis, perforated ulcer, ovarian cyst torsion, intestinal obstruction, ectopic pregnancy, abruptio placenta, tumor, or hernias (Ramirez et al, 1997;Klingler et al, 2000;Ozaras et al, 2003). Questioning underlying diseases or conditions, any precipitating event, and abdominal examination are vitally important.…”

“…The most common abdominal wall hematoma is spontaneous rectus sheath hematoma caused by the rupture of either the distal branch of the inferior epigastric artery or deep circumflex iliac artery, but a spontaneous hematoma involving the lateral abdominal wall is extremely rare (Nakayama et al, 2008). It may mimic other acute abdominal disorders and is more commonly seen in elderly women, particularly if they are under anticoagulant therapy, or have a chronic cough or cardiovascular disease (Ozaras et al, 2003).…”