title: Spontaneous rectus sheath hematoma: an analysis of 15 cases.
abstract: BACKGROUND
  Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.
  
  
  METHODS
  This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).
  
  
  RESULTS
  All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.
  
  
  CONCLUSIONS
  Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.
authors.affiliation: Department of General Surgery, İstanbul University, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Carkman
authors.forename: Volkan
authors.initials: V
authors.lastname: Ozben
authors.forename: Kağan
authors.initials: K
authors.lastname: Zengin
authors.forename: Erkan
authors.initials: E
authors.lastname: Somuncu
authors.forename: Adem
authors.initials: A
authors.lastname: Karataş
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000139:chemically induced / Q000150:complications* / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011859:Radiography; D017568:Rectus Abdominis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin