The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders

Abstract

RSH is a rare condition that is usually associated with abdominal trauma and/or anticoagulation therapy. Ultrasound is a good screening technique. Nonsurgical therapy is appropriate but leads to a greater need for analgesics. Surgery should be restricted to cases with a large hematoma or free intraabdominal rupture.

Conservative management of a progressively growing rectus sheath hematoma presented in a patient with chronic renal failure: A case report

“…The incidence rate was estimated to be 3.5 per 100,000 per year, with a frequency of approximately 0.9% in patients admitted with acute abdominal pain [6]. It is reported to be three times more frequent in women than in men, with a peak incidence found in the fifth decade [3].…”

“…Still it may occur without obvious direct trauma or underlying systemic disease. In such cases, hematoma follows muscular straining as in sports, exercise, sneezing, coughing or childbirth [2,3,7]. The spontaneous occurrence of RSH in this case seems to multifactorial and mainly related to the chronic renal failure induced atherosclerosis as well as to the anticoagulation required for haemodialysis.…”

“…RSH has been mistaken for many acute abdominal diseases such as appendicitis [14], incarcerated inguinal hernia, perforated duodenal ulcer [3], acute cholecystitis, mesenteric vascular insult, dissecting aortic aneurysm, pregnancy, urinary obstruction and torsion of ovarian cysts. Differential diagnosis includes less frequently desmoid tumors, sarcomas and echinococchal cysts in the muscular layer [3,9].…”

“…Adequate diagnosis is made in only 30-50% of cases at admission [3]. The failure rate to recognize this condition is responsible for a high rate of needless surgical interventions that may raise morbidity and mortality unnecessarily [2].…”

Type III Rectus Sheath Hematoma: A Case Report

“…Bir çalışmada rektus kılıf hematomunun akut karın ağrısı nedeniyle hastaneye başvuran ve tanı için ultrasonogrofiye yönlendirilen hastaların %1.8'inde tespit edildiği gösterilmiştir. [3] Daha çok 6. dekatda ve daha az rektus kas kütlesine sahip olma eğilimi gösterdiğinden kadınlarda yaklaşık 2 kat daha sık görülür. [4] Rektus kılıf hematomunun mortalitesi %1.6-25 arasında olduğu gösterilmiştir.…”