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Rectus Sheath Hematoma: A Diagnostic and Therapeutic Dilemma

Ioannis K. Skandalos, Stavros C. Kalfadis, Styliani N. Parpoudi, Ioannis A. Kirmizis, Niki A. Krasia, Eirini G. Sidiropoulou, Evaggelos M. Pertsas, Stamatios A. Boutsioukis, Konstantinos G. Tsalis

Department of Surgery, General Hospital Agios Pavlos, Thessaloniki, Greece

Med Sci Rev 2015; 2:19-23

DOI: 10.12659/MSRev.893338

Available online:

Published: 2015-03-02


ABSTRACT: Background:  We present a series of 16 patients (8 women and 8 men) treated for a rectus sheath hematoma from January 2009 until June 2014. The main symptoms of all patients were abdominal pain and abdominal wall distention. Twelve patients had a history of receiving anticoagulant treatment. Provoking factors referred were persistent coughing in 4 patients, intramuscular injection of LMWH in 1 patient, and coagulopathy after extensive gastric bleeding in 1 patient. In 2 patients the hematoma was occurred after a car accident, in 2 patients after intense uncoordinated contraction of the rectus abdominis muscles, in 1 patient the hematoma was presented postoperatively after surgery in lower abdomen, and in 1 patient the hematoma occurred spontaneously. Hematocrit value varied from 21.8% to 41%, while in all patients who were treated with vitamin K antagonists, the INR value was prolonged (>3.2).
Material and Methods: Between January 2009 and June 2014, we treated 16 patients (8 women and 8 men) for a rectus sheath hematoma. The diagnosis was established with US imaging and CT scanning.
Results: Twelve patients were treated conservatively and 3 patients underwent surgery. Eight patients required blood transfusions and 4 of them received fresh frozen plasma. One patient died on the 7th day of hospitalization because of chronic respiratory insufficiency. The hospital stay ranged from 3 to 32 days.
Conclusions: A rectus sheath hematoma should be taken into consideration in the differential diagnosis of acute abdominal pain, especially in patients receiving anticoagulant therapy. The diagnosis is confirmed by US imaging and mainly by CT scanning. Therapy is conservative or surgical according to the severity of the hematoma.

Keywords: Abdomen, Acute, Abdominal Pain, Anticoagulants, Epigastric Arteries, Hematoma, Rectus Abdominis