title: Spontaneous rectus sheath hematoma in patients on anticoagulation therapy.
abstract: BACKGROUND
  This clinical study was conducted to present the clinical features, treatment and outcomes of rectus sheath hematoma (RSH), which is a complication of anticoagulation therapy that can present as acute abdomen.
  
  
  METHODS
  Twenty-two spontaneous RSH cases who were on anticoagulation therapy were reviewed. Patient characteristics, anticoagulant therapy form and indications, clinical presentation, radiologic work-up, treatment modalities, recurrence, morbidity, and follow-up data were analyzed.
  
  
  RESULTS
  The majority of the patients were female (64%), and the mean age was 60.6 years. All of the patients (100%) were receiving at least one form of anticoagulation therapy; most (72%) were on warfarin therapy. History of coughing was found in 45% of the cases. The most common presenting signs and symptoms were abdominal pain and mass (77%). International normalized ratio (INR) was >3.0 in all patients on warfarin therapy. The diagnosis was made by abdominopelvic ultrasonography (US) and computerized tomography (CT). CT showed 100% sensitivity. The majority of patients (87%) were treated conservatively. Three patients (13%) were operated and 2 patients (9%) died as a result of RSH. Two patients experienced recurrence in one year.
  
  
  CONCLUSIONS
  RSH should be suspected in elderly, coughing patients on anticoagulation therapy, who present with clinical manifestations of acute abdomen. Early diagnosis can help to avoid increased morbidity or unnecessary surgical intervention.
authors.affiliation: Department of General Surgery, Mersin University Faculty of Medicine, Mersin, Turkey. ahmetdag@yahoo.com
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dağ
authors.forename: Turkay
authors.initials: T
authors.lastname: Ozcan
authors.forename: Ozgür
authors.initials: O
authors.lastname: Türkmenoğlu
authors.forename: Tahsin
authors.initials: T
authors.lastname: Colak
authors.forename: Kerem
authors.initials: K
authors.lastname: Karaca
authors.forename: Hakan
authors.initials: H
authors.lastname: Canbaz
authors.forename: Musa
authors.initials: M
authors.lastname: Dirlik
authors.forename: Ramazan
authors.initials: R
authors.lastname: Sarıbay
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D004638:Emergency Treatment; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin