Hemorrhagic shock and obstructive uropathy due to a large rectus sheath hematoma in a patient on anticoagulant therapy.
A 54-year-old woman was transferred to our hospital with disseminated intravascular coagulation, and was treated with heparin. On hospitalization day 13, she developed lower abdominal pain and mass followed by circulatory shock. She became oliguric and laboratory tests showed serum creatinine of 3.5 mg/dL and hemoglobin of 7.4 g/dL. Computed tomography showed hematoma in the left rectus sheath, compressing the urinary bladder exteriorly, which resulted in worsening of bilateral hydronephrosis. Conservative treatment resulted in resolution of the rectus sheath hematoma and improvement of renal function. Rectus sheath hematoma can be treated conservatively without surgical intervention even in complicated cases.
Toyonaga
Jiro
J
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka.
Tsuruya
Kazuhiko
K
Masutani
Kohsuke
K
Maeda
Hiroto
H
Nakamura
Kuniyuki
K
Taniguchi
Masatomo
M
Hirakata
Hideki
H
Iida
Mitsuo
M
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006406:Hematoma / Q000139:chemically induced* / Q000150:complications* / Q000000981:diagnostic imaging; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D017568:Rectus Abdominis / Q000473:pathology; D012771:Shock, Hemorrhagic / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging / Q000209:etiology*
D000925:Anticoagulants; D006493:Heparin