Rectus Sheath Hematoma: Acute Abdominal Pain Associated with Coughing

Creative Commons License

Aydın H., Kaya M., Kadıoğlu E., Çoşkun A., Yıldırım H.

2nd Southeast European Congress of Emergency and Disaster Medicine 20 - 22 July 2019 İstanbul, İstanbul, Türkiye, 20 - 22 Haziran 2019, ss.115, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.115
  • Kütahya Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

Introduction RKH is a rare but potentially life-threatening condition (1). Advanced age, anticoagulant use, coughing, heavy exercise, intraabdominal drug injection, trauma, hematological diseases, and pregnancy are risk factors of RSH(2). Ultrasound and computed tomography(CT) can confirm the diagnosis. Treatment can be achieved with a conservative approach (discontinue anticoagulant use and giving vitamin K, fresh frozen plasma (FFP), erythrocyte Suspension (ES) and fluid resuscitation)(3). In rare cases, hemodynamia may be unstable due to hematoma growth. Therefore, surgical arterial ligation and intraarterial embolization may be required. Case A 73-year-old female patient was admitted to the emergency department with sudden onset of abdominal pain and swelling after coughing. She had a blood pressure of 100/60 mm Hg and a heart rate of 90 beats/min. The patient has a history of 5 mg warfarin daily due to arrhythmia. In the palpation of the abdomen, there was swelling, sensitivity and voluntary defense from the right upper quadrant to the right lower quadrant. Hemoglobin level was 12 (normal 11,5-16,5) g/dl, platelet count 300.000 (normal 130.000-400.000) / L, international normalized ratio was 3,79. There was intramuscular hematoma (sizes reaching 15cmx7cm) in the rectus abdominis and transverse abdominis muscles in the scan of abdominal CT. (Figure 1)Three units of ES, two units of Fresh Frozen Plasma (FFP) were given for treatment and warfarin was discontinued. After 5 days, hemodynamia was stabilized and she was discharged from hospital with a cure. Conclusion As a result, delay in diagnosis for rectus sheath hematoma in the emergency department may increase mortality because of the treatment shift from the conservative approach to surgery. intramuscular hematoma in the rectus abdominis and transverse abdominis muscles in the scan of abdominal computed tomography Keywords:Rectus Sheath Hematoma;Abdominal Pain ;Coughing