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Case Reports
. 2022 Sep 5;14(9):e28795.
doi: 10.7759/cureus.28795. eCollection 2022 Sep.

Hernia Following Rectus Sheath Hematoma

Adam Dulberger  1 , Mitchell Streiff  2 , Scott D Myers  1 , Christopher S Sanders  3
Affiliations
Case Reports

Hernia Following Rectus Sheath Hematoma

Adam Dulberger et al. Cureus. .

Abstract

Rectus sheath hematomas (RSH) are increasing in prevalence, presumably correlating with increased use of anticoagulation medications and an aging population. Comorbidities such as blood dyscrasias, atherosclerosis, and hypertension are associated with an increased risk of developing an RSH. Iatrogenic origin of RSH, secondary to treatment of various abdominal pathologies, is not uncommon. Due to its exceptionally non-specific array of clinical signs and symptoms, RSH can be challenging to diagnose in the clinical setting without the aid of radiological images. Abdominal computed tomography (CT) is generally the modality of choice through which the RSH can be successfully identified and characterized. CT imaging can play an important role in the planning of RSH management, as effective management varies depending on the size and position of the RSH. Recurrent bleeding, hypovolemic shock, abdominal compartment syndrome, myonecrosis, and infection have been traditionally considered as the more prominent complications of RSH. However, with more cases occurring, more complications are being described in the literature. The following case presents a previously unreported complication of RSH, that of bowel herniation into a potential space created by a previously treated RSH.

Keywords: abdominal wall hernia; posterior rectus sheath hematoma; rectus hematoma; rectus sheath hematoma; rectus sheath hernia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Active extravasation of the right inferior epigastric artery leading to a rectus sheath hematoma
Figure 2
Figure 2. Inferior epigastric artery demonstrating active extravasation on angiography
Figure 3
Figure 3. Appearance following embolization performed by Interventional Radiology
Figure 4
Figure 4. Herniation of bowel into space created by previous rectus sheath hematoma (axial)
Figure 5
Figure 5. Herniation of bowel into space created by previous rectus sheath hematoma (axial)
Figure 6
Figure 6. Herniation of bowel into space created by previous rectus sheath hematoma (sagittal)
Figure 7
Figure 7. CT following surgical mesh repair of the hernia
See this image and copyright information in PMC

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