Spontaneous rectus sheath hematoma associated with warfarin administration: a case report

Abstract

Objectives: Rectus sheath hematoma (RSH) can result from bleeding into the rectus abdominis muscle or a direct muscular tear; nontraumatic spontaneous RSH is a rare condition. Here, we report a case of spontaneous RSH associated with warfarin administration for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).Patient: An 87-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting for 3 days. She was receiving warfarin for treating CTEPH. She had a bulging and hard lower abdomen with ecchymosis. Moreover, the bulging portion was highly tender, and a positive Carnett’s sign was also observed. She reported no history of abdominal trauma. Abdominal computed tomography (CT) scan revealed right RSH.Results: She was diagnosed with spontaneous RSH and admitted to our hospital. Warfarin was antagonized with an intravenous injection of vitamin K; hemostatic agents were intravenously administered. Gradually, her abdominal pain improved. She was finally discharged 12 days after the admission. Abdominal CT scan performed 17 days after the discharge revealed a reduction in the size of RSH.Conclusion: Despite not having a history of trauma, it is necessary to consider the possibility of RSH for patients receiving warfarin and complaining of abdominal pain.

Transcatheter arterial embolization as an effective treatment for spontaneous inferior epigastric artery bleeding caused by anticoagulant therapy: Case reports

“…RSH accounts for 1-2% of acute abdominal syndrome cases (2,5,8,11). Although its incidence is rare, certain studies have reported a high mortality rate of up to 25% with anticoagulant therapy (2,4,11,12).…”

“…Although its incidence is rare, certain studies have reported a high mortality rate of up to 25% with anticoagulant therapy (2,4,11,12). The etiology of RSH includes trauma, intensive muscle contractions, and iatrogenic and anticoagulant therapy (2,3,5,12,13). Anticoagulant therapy is one of the major risk factors of RSH (14).…”

“…In a previous study, Cherry and Mueller reviewed 126 RSH cases and found that 25% of the patients received anticoagulant therapy (14). SIEAH is a relatively rare condition of RSH (2,5). The pathophysiology of SIEAH remains unclear.…”

“…Spontaneous inferior epigastric artery hemorrhage (SIEAH) is a rare condition and can lead to rectus sheath hematoma (RSH), and may thus prove potentially fatal condition (1)(2)(3)(4)(5). Bleeding can lead to hematoma and tamponade; therefore, this episode may be self-limited (2,(6)(7)(8).…”

“…Anticoagulant therapy has been reported to be a risk factor of mortality (1,3,4). Other risk factors of SIEAH include hypertension, pregnancy, atherosclerosis, obesity, the use of corticosteroids, thrombophilia and leukemia (1,5,8). Initially, conservative treatment, including blood transfusion, anticoagulation therapy and coagulation parameter correction, is the most commonly used treatment (1,2,4,9,10).…”