Diagnostic evaluation and treatment of patients with rectus abdominis hematoma

Abstract

Purpose: To identify clinical characteristics, treatment modalities, and course of spontaneous rectus sheath hematoma (SRSH). In the literature, there is no prospective clinical trial that is intended for treatment in clinical research.

Methods: Seventeen SRSH patients diagnosed and treated between March 2012 and March 2014 at the general Surgery Department of Erzincan University Training and Research Hospital were included. Age, sex, weight, height, predisposing factors, comorbid diseases, Charlson index, current medical treatment, physical examination signs, imaging methods, lowest hemoglobin value, blood type, SRSH type, INR/Factor V Leiden mutation/Factor VII/Factor VIII/Factor X/Protein S/Protein C values, treatment method, transfusions hospitalization duration, and outcome were studied.

Results: Thirteen patients were female. The mean age was 63.3 ± 18.7 years (range, 22-87 years), and the mean BMI was 27.8 ± 3.5 (range, 20.9-33.7). Six patients had Grade I SRSH, 5 had Grade II SRSH, and 6 had Grade III SRSH. Thirteen were hospitalized for a mean duration of 9.3 ± 8.1 days (range, 1-30 days). The death rate attributable to SRSH was 5.8%.

Conclusion: Early diagnosis of SRSH by ultrasonography and/or computerized tomography is important for a low mortality rate. Even though medical treatments are important, arterial embolization by interventional radiology, or more radical interventions such as surgery, may be required.

Keywords: Abdominal wall disease; Anticoagulant therapy; Diagnosis; Diagnóstico; Enfermedad de la pared abdominal; Hematoma espontáneo de la vaina del recto; Spontaneous rectus sheath hematoma; Tratamiento; Tratamiento anticoagulante; Treatment.