Rectus sheath hematoma: Review of 126 cases at a single institution

W. Brett Cherry, Paul Mueller

Research output: Contribution to journalReview article

153 Citations (Scopus)

Abstract

Rectus sheath hematoma (RSH) is an uncommon condition characterized by abdominal pain and an abdominal wall mass. We reviewed the clinical features, treatment, and outcomes of 126 patients treated for RSH at Mayo Clinic from January 1, 1992, to December 31, 2002. Most patients (64%) were women and the mean ± SD age was 67.9 ± 16.5 years. Most patients (69%) were on some form of anticoagulation therapy. The mean international normalized ratio was 2.6 ± 2.4, and mean activated partial thromboplastin time was 64.2 ± 42.7 seconds. No patients were pregnant or had a peritoneal dialysis catheter at the time of diagnosis. Approximately half of the patients (48%) had nonsurgical abdominal trauma around the time of diagnosis, with 37 patients (29%) having a cough. The most common presenting signs and symptoms were abdominal pain (84%) and an abdominal wall mass (63%). CT of the abdomen and pelvis was the most commonly used method to establish the diagnosis (83%). Most patients (86%) were successfully treated with symptom management and blood transfusion. Ten patients (7.9%) underwent surgery or endovascular embolization of bleeding vessels, and 2 patients (1.6%) died as a result of RSH bleeding. Although RSH is rarely fatal, the clinician should be aware of important risk factors that lead to RSH including female sex, older age, anticoagulation therapy, and cough or other abdominal trauma. Rapid diagnosis with directed history, physical examination, and CT of the abdomen and pelvis may help decrease unnecessary laparotomy and lead to better triage of patients who present with RSH.

Original languageEnglish (US)
Pages (from-to)105-110
Number of pages6
JournalMedicine
Volume85
Issue number2
DOIs
StatePublished - Mar 1 2006

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Hematoma
Abdominal Wall
Pelvis
Cough
Abdomen
Abdominal Pain
Hemorrhage
International Normalized Ratio
Partial Thromboplastin Time
Triage
Wounds and Injuries
Peritoneal Dialysis
Blood Transfusion
Laparotomy
Signs and Symptoms
Physical Examination
Catheters
History
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rectus sheath hematoma : Review of 126 cases at a single institution. / Cherry, W. Brett; Mueller, Paul.

In: Medicine, Vol. 85, No. 2, 01.03.2006, p. 105-110.

Research output: Contribution to journalReview article

Cherry, W. Brett ; Mueller, Paul. / Rectus sheath hematoma : Review of 126 cases at a single institution. In: Medicine. 2006 ; Vol. 85, No. 2. pp. 105-110.
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