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. 2019 Nov;14(2):245-248.
doi: 10.2185/jrm.3010. Epub 2019 Nov 20.

Spontaneous rectus sheath hematoma associated with warfarin administration: a case report

Koji Takahashi  1 , Takeshi Nihei  1 , Yohei Aoki  1 , Miyuki Nakagawa  1 , Naoaki Konno  1 , Akari Munakata  1 , Ken Okawara  1 , Hiroshi Kashimura  1
Affiliations

Spontaneous rectus sheath hematoma associated with warfarin administration: a case report

Koji Takahashi et al. J Rural Med. 2019 Nov.

Abstract

Objectives: Rectus sheath hematoma (RSH) can result from bleeding into the rectus abdominis muscle or a direct muscular tear; nontraumatic spontaneous RSH is a rare condition. Here, we report a case of spontaneous RSH associated with warfarin administration for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Patient: An 87-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting for 3 days. She was receiving warfarin for treating CTEPH. She had a bulging and hard lower abdomen with ecchymosis. Moreover, the bulging portion was highly tender, and a positive Carnett's sign was also observed. She reported no history of abdominal trauma. Abdominal computed tomography (CT) scan revealed right RSH. Results: She was diagnosed with spontaneous RSH and admitted to our hospital. Warfarin was antagonized with an intravenous injection of vitamin K; hemostatic agents were intravenously administered. Gradually, her abdominal pain improved. She was finally discharged 12 days after the admission. Abdominal CT scan performed 17 days after the discharge revealed a reduction in the size of RSH. Conclusion: Despite not having a history of trauma, it is necessary to consider the possibility of RSH for patients receiving warfarin and complaining of abdominal pain.

Keywords: Carnett’s sign; abdominal pain; rectus sheath hematoma; warfarin.

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Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
Non-contrast-enhanced abdominal computed tomography (CT) scan at admission. (a) axial image; (b) sagittal image. CT scan shows a hematoma in the right rectus sheath (arrow).
Figure 2
Figure 2
Non-contrast-enhanced abdominal computed tomography (CT) scan 17 days after discharge. (a) axial image; (b) sagittal image. CT scan reveals a reduction in the size of hematoma (arrow).
See this image and copyright information in PMC

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