Subcutaneous Heparin Leads to Rectus Sheath Hematoma: A Rare Complication

Abstract

Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with prophylactic dose of heparin. Early recognition is necessary to decrease morbidity and mortality. RSH should be considered in anticoagulated patients who develop sudden onset of abdominal pain. RSH is usually managed conservatively, but sometimes requires surgery. Patients who are taking antiplatelet require careful monitoring with the use of anticoagulation (AC). It is important to identify them early. This is a case of 69-year-old female who presented with epigastric pain secondary to rectus sheath hematoma. She was receiving subcutaneous injections of heparin for left lower quadrant pain and swelling for venous thromboembolism prophylaxis. Ultrasound of abdomen revealed large rectus sheath hematoma.

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

“…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).…”

“…The most common presentation of SIEAH is abdominal pain (2,8,11,12), which can become aggravated with the patient's movements (2,3,5,8). The typical finding during physical examination is an abdominal mass, which does not cross the middle abdomen (2,3,5,7,8). Peritoneal signs, such as muscle guarding or rebounding pain, may be positive; therefore, the presentation can mimic that of acute abdominal syndrome (3,7,8,11,12).…”

“…The typical finding during physical examination is an abdominal mass, which does not cross the middle abdomen (2,3,5,7,8). Peritoneal signs, such as muscle guarding or rebounding pain, may be positive; therefore, the presentation can mimic that of acute abdominal syndrome (3,7,8,11,12). Laboratory data may reveal normal coagulation function even with active bleeding (2,11).…”

“…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).…”

“…However, in some cases, hemorrhaging can result in hypovolemic shock or even death. 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).…”