Rectus sheath haematoma (RSH) mimicking acute intra-abdominal pathology.
OBJECTIVE
Rectus sheath haematoma (RSH) is a rare cause of acute abdomen. We present a case series of patients seen at Wanganui Hospital, North Island, New Zealand.


METHODS
A retrospective survey of patients developing RSH over a 2-year period (from 2002 to 2004) in our hospital was carried out.


RESULTS
Seven patients were identified with RSH (male:female ratio=6:1, age range=16-80 years). Six of the RSH were spontaneous and four out of these six were on anticoagulant therapy post-acute coronary event. Each presented with acute abdomen and all were missed on initial evaluation. Two were diagnosed initially as bowel obstruction, one as acute diverticulitis, one as incarcerated hernia, one as an ovarian mass, and another as non-specific abdominal pain. One patient had traumatic RSH with peritonitis secondary to accompanying jejunal perforation. The ultrasound pick-up rate was 50% of but computed tomography (CT) abdomen was 100% diagnostic. Five (70%) had a significant fall in haematocrit, requiring blood transfusion. All settled on conservative management, with one requiring admission to intensive care.


CONCLUSIONS
Clinical diagnosis of RSH is unreliable. CT imaging is the procedure of choice and should be promptly carried out especially in those on anticoagulant therapy for early diagnosis and proper management.
Khan
Mohammad Imran
MI
Department of Medicine and Radiology, Wanganui Hospital, Wanganui, New Zealand. nidha99@yahoo.com
Medhat
Osman
O
Popescu
Octavian
O
Rastogi
Amit
A
Thompson
Tom
T
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006406:Hematoma / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012002:Rectal Diseases / Q000139:chemically induced*; D012007:Rectum / Q000098:blood supply; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants