title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno Gallego
authors.forename: J L
authors.initials: JL
authors.lastname: Aguayo
authors.forename: B
authors.initials: B
authors.lastname: Flores
authors.forename: T
authors.initials: T
authors.lastname: Soria
authors.forename: Q
authors.initials: Q
authors.lastname: Hernández
authors.forename: S
authors.initials: S
authors.lastname: Ortiz
authors.forename: R
authors.initials: R
authors.lastname: González-Costea
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D011859:Radiography; D017568:Rectus Abdominis / Q000098:blood supply*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography