Document Type : Review articles
Authors
- Tooraj Zandbaf 1
- Mohammad Ebrahim Kalantari 2
- Yeganeh Azadmanesh 3
- Hamzeh Sherafati 4
- Ali Akbar Bagherzadeh 5
1 Assistant Professor of General Surgery, Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
2 Minimally invasive and Bariatric Surgeon, Surgical oncology research center, Mashhad University of medical sciences, Mashhad, Iran
3 General Practitioner, Department of Emergency Medicine, Razavi Hospital, Mashhad, Iran
4 Resident of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
5 General Practitioner, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
Abstract
Introduction: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities.
Case presentation: The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated Covid-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism; therefore, the therapeutic dose of heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical; nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7.9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle.
Conclusion: In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.
Keywords
- Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: A review of the literature. Int J Surg. 2015;13:267–71. doi: 10.1016/j.ijsu.2014.12.015. [PubMed: 25529279].
- Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Rectus sheath haematoma associated with low molecular weight heparin: A case series. Ann R Coll Surg Engl. 2007;89(3):309–12. doi: 10.1308/003588407X179152 . [PubMed: 17394721]
- Kalayci T. Rectus Sheath Hematoma Due to Low Molecular Weight Heparin in a COVID-19 Patient in Turkey. Cureus. 2021;13(5):5–9. doi:10.7759/cureus.14870 .
- Nematihonar B, Qaderi S, Shah J, zebarjadi Bagherpour J. Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review. Int J Emerg Med. 2021;14(1):1–6. doi: 10.1186/s12245-021-00366-5.
- Bakirov I, Bakirova G, Albalawi Y, Asiri AY, Faqihi F, Bakirli I, et al. Left inferior epigastric artery injury in COVID-19 patient. Case report and literature review. Int J Surg Case Rep. 2020;76:415–20. doi: 10.1016/j.ijscr.2020.09.198. [PubMed: 33042768].
- Dennison JJ, Carlson S, Faehling S, Phelan H, Tariq M, Mubarik A. Splenic infarction and spontaneous rectus sheath hematomas in COVID-19 patient. Radiol Case Reports. 2021;16(5):999–1004. doi: 10.1016/j.radcr.2021.02.016 . [PubMed: 33619439]
', './data/ircmj/coversheet/cover_en.jpg'))