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Case Reports
. 2025 Jul 17;2025(7):rjaf550.
doi: 10.1093/jscr/rjaf550. eCollection 2025 Jul.

Rectus sheath hematoma causing cecal perforation: a case report

Abanoub Awad  1 , Mitchell Meagher  1 , Isaac Theerman  1 , Jason Beckermann  1
Affiliations
Case Reports

Rectus sheath hematoma causing cecal perforation: a case report

Abanoub Awad et al. J Surg Case Rep. .

Abstract

Rectus sheath hematoma is a rare condition caused by bleeding from the epigastric arteries, with an incidence of 1.2-1.5 cases per year. We present a 49-year-old male with a smoking history and recent corona virus disease 2019 (COVID-19) infection who presented with symptoms of an upper respiratory infection and suspected venous thromboembolism. Imaging revealed bilateral pulmonary emboli and a left rectus sheath hematoma, which was initially managed conservatively. However, the patient's condition worsened with a significant drop in hemoglobin and development of encephalopathy. Imaging showed an enlarging hematoma, leading to transfusion and selective embolization. On day 8, the patient developed generalized abdominal pain, and imaging confirmed a hollow viscus perforation. An exploratory laparotomy revealed cecal perforation due to mass effect from the hematoma. An ileocecectomy was performed.

Keywords: abdominal pain; anticoagulation; case report; cecal perforation; rectus sheath hematoma.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
CT scan showing left RSH (arrow).
Figure 2
Figure 2
Grey Turner's sign.
Figure 3
Figure 3
A follow-up CT scan showing progression of the RSH (arrows).
Figure 4
Figure 4
Angiogram of the left inferior epigastric artery (arrow) demonstrating no active bleeding.
Figure 5
Figure 5
CT scan demonstrating pneumo-peritoneum (arrow), indicative of a hollow viscus perforation.
Figure 6
Figure 6
CT scan demonstrating compression of large bowel (arrows) by the enlarged hematoma.
See this image and copyright information in PMC

References

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