The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders.
BACKGROUND
Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Therefore, we designed a study to analyze the etiology, frequency, diagnosis using ultrasound, and treatment of RSH.


METHODS
A total of 1,257 patients admitted for abdominal ultrasound for acute abdominal pain or unclear acute abdominal disorders were evaluated.


RESULTS
In 23 (1.8%) patients, an RSH was diagnosed; three of them were not diagnosed preoperatively by ultrasound. Of 13 men and 10 women (mean age, 57 +/- 23 years), 13 developed RSH after local trauma, three after severe coughing, two after defecation, and five spontaneously. Fifteen had nonsurgical therapy, and eight underwent surgery. The use of anticoagulants was accompanied by a larger diameter of the RSH (p <.012), and surgical therapy was more frequently required in these patients. In the surgically treated group, more intraabdominal free fluid could be detected by ultrasound (p <.0005), patients required less analgesics (p <.001), and the mean hospital stay was shorter (p <.001).


CONCLUSIONS
RSH is a rare condition that is usually associated with abdominal trauma and/or anticoagulation therapy. Ultrasound is a good screening technique. Nonsurgical therapy is appropriate but leads to a greater need for analgesics. Surgery should be restricted to cases with a large hematoma or free intraabdominal rupture.
Klingler
P J
PJ
Department of Surgery, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Wetscher
G
G
Glaser
K
K
Tschmelitsch
J
J
Schmid
T
T
Hinder
R A
RA
D000006:Abdomen, Acute / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D014463:Ultrasonography
D000894:Anti-Inflammatory Agents, Non-Steroidal