By Prodyut Das

Rectus Sheath Hematoma

by Joshua
(New York)

rectus abdominis sheath

rectus abdominis sheath

The terminal branches of the superior and inferior epigastric arteries course deep to the posterior aspect of the left and right rectus pillars and penetrate the posterior rectus sheath. Injury to these vessels or to any of the network of collateralizing vessels within the rectus sheath and muscles can result in a rectus sheath hematoma.

Causes for Rectus Sheath Hematoma
Although there may be a history of significant blunt trauma, less-obvious events also have been reported to cause this condition, such as

  • 1 - sudden contraction of the rectus muscles with coughing, sneezing, or any vigorous physical activity

  • 2 - Spontaneous rectus sheath hematomas have been described in the elderly and in those on anticoagulation therapy

Sign and Symptoms

Patients frequently describe the sudden onset of unilateral abdominal pain that may be confused with lateralized peritoneal disorders such as appendicitis. Below the arcuate line, a hematoma may cross the midline and cause bilateral lower quadrant pain.

History and Physical Examination

History and physical examination alone may be diagnostic. Pain typically increases with contraction of the rectus muscles and a tender mass may be palpated. The ability to appreciate an intra-abdominal mass is ordinarily degraded with contraction of the rectus muscles.

Fothergill's sign is a palpable abdominal mass that remains unchanged with contraction of the rectus muscles and is classically associated with rectus hematoma.

A hemoglobin/hematocrit level and coagulation studies should be obtained. Abdominal ultrasonography may show a solid or cystic mass within the abdominal wall, depending on the chronicity of the bleeding event. Computed tomography is the most definitive study for establishing the correct diagnosis and excluding other intra-abdominal disorders. Magnetic resonance imaging (MRI) also has been employed for this purpose.

Treatment for Rectus Sheath Hematoma

Specific treatment depends on the severity of the hemorrhage. Small, unilateral, and contained hematomas may be observed without hospitalization. Bilateral or large hematomas will likely require hospitalization, as well as potential resuscitation. The need for a red blood cell or coagulation factor transfusion is determined by the clinical circumstances. Reversal of warfarin (Coumadin) anticoagulation in the acute setting is frequently, but not always, necessary. Emergent operative intervention or angiographic embolization is required infrequently, but may be necessary if hematoma enlargement, free bleeding, or clinical deterioration occur. Surgical treatment consists of evacuation of the hematoma and ligation of any bleeding vessel identified. Mortality in this condition is rare, but has been reported in patients requiring surgical
treatment and in elderly.

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Aug 29, 2018
help NEW
by: Anonymous

What kind of doctor can treat/oversee this condition. My husband was diagnosed with this last week and we don't know what kind of doctor to follow up with.

Oct 11, 2015
I suffered this type of hematoma on Saturday, September 12, 2015
by: Debra McKinney

I have never ever been in so much pain before in my life. I was driving home from the beach when the pain hit me. I had not had any trauma. Finally pulled off the side of the road and called 911. I was 50+ miles from a hospital and couldn't get anything for pain being I'm allergic to morphine. In the ER they did a cat scan with dye. The doctor said I was very lucky to be alive. The next couple of days were a blurr. Days later I ended up at a rehabilitation facility. The nurses were horrible along with the CNA's. The rehabilitation people were great. I would hate to think I had a loved one there. I'm still in pain but I'm home and don't have anyone to help me. I'll be glad when I can drive and get around on my own. I'm very thankful I'm alive.

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