Rectus sheath hematoma of the abdomen an uncommon diagnostic challenge.

Awe J.A.A¹ and Soliman AM²

¹Associate Professor of Surgery and Consultant General Surgeon, Department of Surgery, College of Health Sciences, Igbinedion University, Okada, Edo State. Nigeria.

² Senior Surgical Registrar, Northern Area Armed Forces Hospital, King Khalid Military City, P.O. Box 10018, Hafr Al-Batin 31991, Saudi Arabia.

Corresponding Author’s Email: doset2007@yahoo.com

Accepted 19 October, 2013

Abstract

Rectus sheath hematoma of the abdomen (RSH) is accumulation of blood in the sheath of the rectus abdominis muscle as a result of disruption of the epigastric vessels or from a direct tear of the muscle itself. It is a well-documented clinical entity; though uncommon and often clinically misdiagnosed cause of lower abdominal pain. It encompasses a wide spectrum of severity some self-limiting and others fatal depending on its size, aetiology, and the development of complications. Common historical features of RSH include acute abdominal pain, fever, nausea, and vomiting. The nonspecific nature of these symptoms combined with the low incidence of the disorder lead to difficulty in diagnosing it pre-operatively. The haematoma usually occurs in the lower quadrants of the abdominal wall, difficult to diagnose clinically and often radiologic imaging is required for its definitive pre-operative diagnosis. They could be caused by local trauma, coagulopathies, coughing, hypertension, and peripheral vascular disease. The authors present this thirty two (32) year-old female who presented with acute painful lower abdominal mass few days post caesarean section. It is presented to raise the awareness in considering this entity in the differential diagnosis and management of acute lower abdominal pain with probable palpable tender mass. RSH early diagnosis and appropriate treatment may help to prevent complications including correction of hemodynamic instability, the abdominal compartment syndrome or multi-organ dysfunction or even death.

Keywords: Rectus, Muscle, Sheath, Haematoma.