Rectus sheath hematoma
XXI. National Emergency Medicine Congress & XII. Intercontinental Emergency Medicine Congress, XII. International Critical Care and Emergency Medicine Congress ICEM25, Antalya, Turkey, 17 - 20 April 2025, (Summary Text)
- Publication Type: Conference Paper / Summary Text
- City: Antalya
- Country: Turkey
- Kütahya Health Sciences University Affiliated: Yes
Abstract
Ref No: 5848
Rectus sheath hematoma
Fikret Çelik1, Abdil Coşkun1, Murtaza Kaya1, Harun Yıldırım1, Ali Halıcı1, Ertan Sönmez1
1Kütahya Sağlık Bilimleri Üniversitesi
Introduction and Purpose: Rectus sheath hematoma (RSH) is the accumulation of blood within the rectus sheath muscle in the abdomen, resulting from damage to the epigastric arteries or a direct muscle tear. In this case we wanted to emphasize that rectus sheath hematoma is one of the causes of acute abdominal pain and highlight the importance of not overlooking it, especially in trauma patients in the emergency department.
Materials and Methods: Case presentation A 79-year-old male patient presented to our emergency department with abdominal pain after falling on his left lumbar region from his own height last evening.Medical History: Chronic kidney disease, atrial fibrillation, hypertension, and COPD.Vital Signs:Stable, Temperature: 36.5°C, Heart rate: 90 bpm, Blood pressure: 135/84 mmHg. The patient is on dialysis and warfarin therapy. No known drug allergies. No significant family history. Physical Examination: No ecchymosis on inspection. Tenderness in the left lower quadrant on deep palpation. No acute abdomen, guarding, or rebound tenderness. Laboratory Findings: WBC: 11.59 × 10⁹/L HGB: 12.5 g/dL Neutrophil percentage: 79.4% Creatinine: 4.94 mg/dL (consistent with patient’s baseline) CRP: 83 mg/L BUN: 26.2 mg/dL Urea: 56.1 mg/dL INR: 11.80 APTT: 74.9 seconds Prothrombin Time: 114 seconds Imaging & Initial Management: Abdominal CT scan was performed. Due to elevated INR, the patient received 10 mg of IV vitamin K and IV 60 ml PCC. Ceftriaxone 1g was administered. Paracetamol 1g was given for pain management. CT Report: Fluid-density collection observed within the left rectus muscle, consistent with intramuscular hematoma. An additional 5.5 cm fluid collection was seen inferior to the left rectus muscle. Further Management: Warfarin was stopped until acute bleeding ceased. LMWH was planned to be started once INR fell below 2. Hospital Course & Discharge: Repeat INR (after 3 hours): 1.73 The patient was admitted to the general surgery service. During follow-up, the hematoma regressed, and vital signs remained stable. The patient was discharged with a scheduled outpatient follow-up in the general surgery clinic. The patient’s CT image
Results and Conclusion: Rectus sheath hematoma is an uncommon condition that can often be managed conservatively. Patients on warfarin presenting with abdominal pain should be evaluated for the possibility of a rectus sheath hematoma. Keywords: lower abdominal pain, rectus abdominis, rectus sheath hematoma.