Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management

Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated.

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Spontaneous Rectus Sheath Hematoma: Factors Predictive of Conservative Management Failure

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.06.009 ◽

2020 ◽

Vol 31 (2) ◽

pp. 323-330 ◽

Cited By ~ 2

Author(s):

Benjamin N. Contrella ◽

Auh Whan Park ◽

Luke R. Wilkins ◽

Daniel Sheeran ◽

Taryn E. Hassinger ◽

...

Keyword(s):

Conservative Management ◽

Rectus Sheath ◽

Rectus Sheath Hematoma

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Unusual Site Hemorrhagic Complications of Anticoagulantion

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1656470 ◽

2016 ◽

Vol 01 (01) ◽

pp. 033-036

Author(s):

A. Kumar

Keyword(s):

Acute Abdomen ◽

Rectus Sheath ◽

Upper Airway ◽

The Elderly ◽

Intestinal Wall ◽

Bleeding Complications ◽

Unusual Site ◽

Rectal Sheath ◽

Rectus Sheath Hematoma ◽

Inherent Quality

AbstractAnticoagulation has inherent quality to produce bleeding complications, more frequently in the elderly. Usual sites following anticoagulation is gastrointestinal, nasal, intracranial hemorrhage or petechial bleed. Here were reporting unusual sites of anticoagulation induced bleed. Rectus sheath hematoma is an unusual bleeding site, can mimic acute abdomen. Bleeding into intestinal wall can produce intussusception and presentation will be again as acute abdomen. Similarly, Sub lingual space is an unexpected site of bleeding and can present as upper airway obstruction or esophageal obstruction. Here we report one case of rectal sheath hematoma, 2 cases of sublingual hematoma and one case in the intestinal wall hematoma due to oral anticoagulation.

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Surgical Management of Left Upper Quadrant Sided Rectus Sheath Hematoma Occurred by Coughing in a Hemodialysis Patient

International Surgery ◽

10.9738/intsurg-d-13-00283.1 ◽

2015 ◽

Vol 100 (1) ◽

pp. 190-192 ◽

Cited By ~ 1

Author(s):

Sangchul Yun ◽

Sungwoo Cho ◽

Zisun Kim ◽

Han Ul Chong ◽

Jae Joon Kim

Keyword(s):

Surgical Management ◽

Surgical Approach ◽

Conservative Management ◽

Hemodialysis Patient ◽

Rectus Sheath ◽

Rectus Abdominis Muscle ◽

Inferior Epigastric Artery ◽

Epigastric Artery ◽

Field Of Vision ◽

Rectus Sheath Hematoma

Abstract Rectus sheath hematoma (RSH) is a rarely-occurring disease that is usually associated with anticoagulation, trauma, or spontaneous events. Most spontaneous rectus sheath hematomas may be relieved with conservative management. However, some extreme situations need surgical approach. Respecting the fact that the inferior epigastric artery mainly supplies the rectus abdominis muscle, interrupting its proximal side would cease the bleeding. We present a stepped procedure of ligation of the inferior epigastric artery and evacuation of hematoma with good field of vision in case of rectus sheath hematoma in hemodialysis patient.

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Is conservative management of spontaneous rectus sheath hematoma effective?

SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital ◽

10.5350/semb.20161028021723 ◽

2017 ◽

pp. 71-75

Author(s):

Cemal Kaya ◽

Ufuk Oğuz Idiz ◽

Pınar Yazıcı ◽

Emre Bozkurt ◽

Sinan Ömeroğlu ◽

...

Keyword(s):

Conservative Management ◽

Rectus Sheath ◽

Rectus Sheath Hematoma

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Rectus sheath haematoma complicating dengue haemorrhagic fever-a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20164578 ◽

2016 ◽

Vol 5 (1) ◽

pp. 354

Author(s):

Harharpreet Kaur ◽

Kawalinder Girgila

Keyword(s):

Dengue Hemorrhagic Fever ◽

Rectus Sheath ◽

Hemorrhagic Fever ◽

Haemorrhagic Fever ◽

Course Of Illness ◽

Acute Dyspnoea ◽

Life Threatening ◽

Plasma Leakage ◽

In The Beginning ◽

Rectus Sheath Hematoma

Dengue hemorrhagic fever manifests in various forms, ranging from petechial skin hemorrhages to life threatening hemorrhages. However it is very rare to have muscle hematomas in this condition. We report a case of spontaneous Rectus sheath hematoma complicating dengue hemorrhagic fever. Our patient was a 55 year old female positive for NS1antigen and anti-dengue IgM. She had thrombocytopenia with platelet counts as low as 12000 in the beginning. There was evidence of plasma leakage and acute dyspnoea during the course of illness. On the 5th day though the platelet count had recovered she developed haematoma in the left rectus sheath which was diagnosed on ultrasound and aspirated leading to relief of symptoms. This complication needs to be recognized so that it can be treated early.

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