Spontaneous rectus sheath hematoma as a complication of anticoagulant and antiplatelet therapy: a case report.

• Published in: Recenti progressi in medicina Vol. 110; no. 2; p. 89
• Main Authors: Carlesi, Roberto Maria, Castoldi, Maria Chiara, Rampoldi, Antonio Gaetano, Incorvaia, Cristoforo, Centeleghe, Paola, Gatto, Gemma
• Format: Journal Article
• Language: Italian
• Published: Italy 01.02.2019
• ISSN: 2038-1840
• DOI: 10.1701/3112.31004

Spontaneous rectus sheath hematoma (RSH) is an uncommon and often clinically misdiagnosed cause of abdominal pain, characterized by a presence of blood within rectus muscle sheath, with palpable mass. Hemorrhage may originate from the epigastric artery and branches or directly from rectus sheath rupture. The most frequent cause of hematoma is anticoagulant therapy. Diagnosis is based on ultrasonography and computed tomography. Conservative treatment and, in case of active bleeding, intravascular embolization is the treatment of choice, while surgery is indicated in case of failure of endovascular procedure or in patients with intra-abdominal rupture causing hemodynamic instability and abdominal compartment syndrome. Here we present a case of RSH that developed after hip replacement surgery in a patient on anticoagulant therapy and dual antiplatelet therapy.