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. 2021 Jul 23;14(1):40.
doi: 10.1186/s12245-021-00366-5.

Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review

Behzad Nematihonar #  1 , Shohra Qaderi #  2   3 , Jaffer Shah #  4 , Javad Zebarjadi Bagherpour  5
Affiliations

Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review

Behzad Nematihonar et al. Int J Emerg Med. .

Abstract

Introduction: Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. PRESENTATION OF CASES: (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up.

Discussion: Hemorrhagic issues in COVID-19 patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19 patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery.

Conclusions: These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19 infection.

Keywords: COVID-19; Case report; Muscle hematoma; Rectus sheath hematoma; Sudden adnominal pain; Vascular disease.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest CT scan shows signs of bilateral COVID-19 pneumonia
Fig. 2
Fig. 2
The yellow arrows in the image confirm a huge rectus sheath hematoma
Fig. 3
Fig. 3
The chest CT scan showing typical GGO features in COVID-19 pneumonia
Fig. 4
Fig. 4
The yellow arrows in the image revealed a huge rectus sheath hematoma
See this image and copyright information in PMC

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