Introduction
Rectus sheath hematoma (RSH) is a rare cause of stomach ache which is
underestimated and has significant morbidity and
mortality.1 RSH is the accumulation of blood in the
anterior rectus sheath due to rupture of the epigastric veins or the
rectus muscle.1 It is recognized as a “diagnostic
dilemma” as it can be easily confused with the etiology of many acute
abdominal pains.2 RSH is characterized by presence of
a palpable abdominal mass characterized by acute abdominal pain
following abdominal muscle strain that is caused by trauma, coughing,
sneezing etc. 3
Many cases are referred to as spontaneous rectus sheath hematoma because
they do not have a trauma history. Oral anticoagulation therapy or
anticoagulant therapy administered with low molecular weight heparin are
recognized as the most common risk factors known to be associated with
spontaneous rectus sheath hematoma. Pregnancy, hypertension, previous
abdominal surgery, coagulopathies or anti-platelet therapy have also
been defined as risk factors. 1,4-6 Incidence of
spontaneous rectus sheath hematoma (SRHS) increases upon increased
administration of antiplatelet and anticoagulant therapies, and the
estimated annual rate of SRSH is 1.2% to 1.5%.7
Early diagnosis and treatment are necessary in SRSH to minimize
complications such as hemodynamic instability, abdominal compartment
syndrome, multiple organ dysfunction syndrome, and death. Treatment
options include conservative, interventional and surgical methods.
Surgery might be fatal for many patients with RSH because they have
other morbidities and hermorrhagic diathesis in advanced age. Therefore,
the surgeon must be aware of the method that will best suit the patient.
Hematoma might restrain itself with the help of conservative treatments
like bed rest, analgesia, and correction of the bleeding disorder in
many cases. Mortality can reach 4% even if SRSH restrains itself with
the help of conservative treatment, and it can reach 25% in patients
using anticoagulants. Radical interventions are required when
conservative treatment modalities fall short.7
In the literature, data relating to rectus sheath hematoma are based on
single center experiences and series with limited number of patients.3,7-10
In this study; we aim to analyze and discuss, in the light of the
literature, the clinical features of patients diagnosed with rectus
sheath hematoma in our clinic over a period of 10 years, and the
therapeutic management and therapeutic results of SRSH.