Diwakar R Sarma*, Vivian Farago, Mark Watson and Jacek Adamek
Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford. Darenth Wood Road. DA2 8DA, UK
Received: 08 July, 2015; Accepted: 29 August, 2015; Published: 02 September, 2015
Mr. Diwakar R Sarma. M.B.B.S, D.N.B, M.R.C.S, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford. Darenth Wood Road. DA2 8DA, UK, E-mail:
Sarma DR, Farago V, Watson M, Adamek J (2015) Spontaneous Rectus Sheath Haematoma – “Less is More”. J Surg Surgical Res 1(3): 033-034. 10.17352/2455-2968.000010
© 2015 Sarma DR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Anterior rectus sheath haematoma is a rare condition that typically arises from rupture of the inferior epigastric artery in patients with coagulation disorder, on anticoagulation, or after abdominal trauma. We report an unusual case of spontaneous rupture of the superior epigastric artery following a violent paroxysm of coughing in a young adult with no known coagulopathy. This case highlights the importance of radiology in clinching the diagnosis and aiding in successful conservative management with complete resolution.
A fit and healthy fifty-five year old lady attended the emergency department with an acute abdomen. She was woken up in the middle of the night by a bout of violent coughing which was followed by sudden-onset severe, sharp pain in the upper abdomen. Initial assessment revealed a tender, irreducible erythematous swelling along the rectus sheath in the right upper quadrant, with no evidence of trauma or clinically detectable herniation. There were no signs of generalized peritonitis, but the swelling was exquisitely tender, tense and stretching the overlying skin.
As patient was haemodynamically stable, a conservative approach was advocated for further evaluation and management. Her serum coagulation screen, haemogram and biochemical parameters were within normal range, a contrast enhanced computer tomography revealed a rectus sheath haematoma likely to have originated from the superior epigastric artery and contained within the rectus sheath (Figure 1). As she remained hemodynamically stable and no correctable predisposing factors were identified, a conservative management plan was put in place. Over the next day she had non-invasive contrast enhanced ultrasonography to delineate any expansion of the haematoma, organisation of the blood clot or further ongoing bleeding. After careful in-hospital monitoring for twenty-four hours, she was discharged home and followed-up regularly in the outpatient clinic, till complete resolution of the haematoma clinically and on serial ultrasounds.
- Gokhale S (2007) High resolution ultrasonography of the anterior abdominal wall. Indian J Radiol Imaging 17: 290-298.
- Alla V, Karnam S, Kaushik M, Porter J (2010) Spontaneous Rectus Sheath Hematoma. West J Emerg Med 11: 76-79.
- Berná JD, Zuazu I, Madrigal M, García-Medina V, Fernández C, et al. (2000) Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdominal Imaging 25: 230-234 .
- Maharaj D, Ramdass M, Teelucksingh S, Perry A, Naraynsingh V (2002) Rectus sheath haematoma: A new set of diagnostic features. Postgrad Me J 78: 755-756.
- Kapan S, Turhan AN, Alis H, Kalayci MU, Hatipoglu S, et al. (2008) Rectus sheath hematoma: Three case reports. J Med Case Rep 2: 22.
- Rimola J, Perendreu J, Falcó J, Fortuño JR, Massuet A, et al. (2015) Percutaneous Arterial Embolization in the Management of Rectus Sheath Hematoma. AJR Am J Roentgenol. 188: W497-502.