Vol. 12 No. 2 (2020): Archives of Public Health
Case Report

Spontaneous rectus sheath hematoma– cause of acute abdomen in patients on anticoagulant therapy: two case reports

Dimitar Petreski
Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
Natalija Cokleska
University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
Lazar Todorovic
University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
Marjan Kamiloski
University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
Shaban Memeti
University Clinic for Pediatric Surgery, Skopje, Republic of North Macedonia
Ljupco Donev
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation, Intensive Care and Emergency Center, Skopje, Republic of North Macedonia
Ljubica Mikjunovikj
University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation, Intensive Care and Emergency Center, Skopje, Republic of North Macedonia

Published 2020-07-16

Keywords

  • spontaneous hematoma,
  • rectus sheath,
  • abdominal pain,
  • management

How to Cite

1.
Petreski D, Cokleska N, Todorovic L, Kamiloski M, Memeti S, Donev L, Mikjunovikj L. Spontaneous rectus sheath hematoma– cause of acute abdomen in patients on anticoagulant therapy: two case reports. Arch Pub Health [Internet]. 2020 Jul. 16 [cited 2021 Dec. 4];12(2):71-80. Available from: https://id-press.eu/aph/article/view/5194

Abstract

(Spontaneus)  Rectus sheath hematoma ((S)RSH) is an accumulation of blood in the sheath of the rectus abdominis muscle, secondary to rupture of an epigastric vessel or muscle tear. It is defined as spontaneous in patients without history of abdominal trauma. It can be located supra- or infraumbilically. Although the exact incidence is unknown, Klingler et al. observed 23 cases (1.8%) of rectus sheath hematoma among 1257 patients evaluated by ultrasound for acute abdominal disorders.  Ultrasonography can help in the diagnosis, but CT scan is most accurate in its ability to define the lesion. When diagnosed clinically, a conservative therapeutic program can usually be instituted. Only in cases of supportive management failure, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated. Case presentation: We present two cases of SRSH in patients using oral anticoagulant agent (acenocoumarol). Their chief complaint was sudden onset of acute abdominal pain. On admission they were haemodynamically stable. After thorough clinical evaluation a suspicion for SRSH diagnosis was made and then confirmed by ultrasonography and CT. Both of them were successfully treated conservatively and discharged home in a good general condition. Conclusion: These two cases illustrate the accurate diagnosis of SRSH treated conservatively leading to optimal patient outcomes.

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