title: Expanding refractory rectus sheath hematoma: a therapeutic dilemma.
abstract: Rectus sheath hematoma is an uncommon but well-described complication of a     tussive paroxysm. It is an accumulation of blood within the sheath of the rectus     abdominis secondary to disruption of the epigastric vessels or the rectus muscle     and is often misdiagnosed as acute abdomen. Increases in the number of elderly     patients and the use of therapeutic anticoagulation may increase the prevalence     and severity of rectus sheath hematomas encountered in clinical practice.     Expanding rectus sheath hematomas are occasionally refractory to conservative     treatment and may require hemostatic intervention. Here, we describe the case of     an 87-year-old woman who presented with two separate rectus sheath hematomas     that were precipitated by a paroxysm of coughing. Repeated computed tomography     showed two separate expanding rectus sheath hematomas, which were not     accompanied by obvious contrast extravasation on angiography. Empiric left     inferior epigastric artery embolization resulted in rapid hemodynamic     stabilization, and the hematomas shrank gradually. Early empiric transcatheter     arterial embolization may be appropriate for patients who are poor surgical     candidates and have enlarging hematomas that are refractory to conservative     treatment.
authors.affiliation: Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan County, Taiwan, Republic of China.
authors.forename: Guo-Shiang
authors.initials: GS
authors.lastname: Tseng
authors.forename: Guo-Shiou
authors.initials: GS
authors.lastname: Liau
authors.forename: Hann-Yeh
authors.initials: HY
authors.lastname: Shyu
authors.forename: Shi-Jye
authors.initials: SJ
authors.lastname: Chu
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Ko
authors.forename: Kuo-An
authors.initials: KA
authors.lastname: Wu
mesh_terms: D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D019074:Epigastric Arteries; D005260:Female; D006406:Hematoma / Q000628:therapy*; D006801:Humans; D009135:Muscular Diseases / Q000628:therapy*; D017568:Rectus Abdominis