Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath haematoma

Abstract

Background: Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This study assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma.

Methods: Thirty cases of rectus sheath haematoma diagnosed over 18 years were reviewed. Mean patient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. Ultrasonography was performed in 21 patients and CT in nine.

Results: Arterial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manifestation was abdominal pain with a palpable mass. Leucocytosis occurred in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 patients. Eight patients required surgery: four for diagnosis and four for treatment.

Conclusion: Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.