title: [Spontaneous rectus sheath hematoma: a rare condition with uneasy diagnosis and multidisciplinary treatment. Report of 5 cases and review of literature].
abstract: Spontaneous rectus sheath hematoma is a rare condition. It encompasses a wide spectrum of severity (self-limiting to fatal) depending of its size, etiology, and the development of complications. It enters into the differential diagnosis of abdominal pain but it's frequently difficult to diagnose and often radiologic imaging is required. Authors report a series of five patients admitted at emergency room within a 2-year period. Patient were between 63 to 78 years old. One of them was in therapy with warfarin, one was in therapy with acetilsalicililate and clopidogrel and in an another patient a coagulation disorder was detected. Diagnosis was suspected in all cases by clinical exam and ultrasonography, but CT-scan was necessary in three cases. All patients underwent conservative treatment, mainly pain relief and rest. In two cases blood transfusion was performed and in two cases clotting abnormalities were corrected with vitamin K and fresh frozen plasma. Average ospedalization was 10 days (range 5-17). One patient developed late seroma and was treated with ultrasound-guided aspiration. Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. The difficulties in the correct diagnosis frequently lead to delay in treatment or unneeded surgery. CT-scan is the gold-standard investigation. Treatment options are variable and include conservative treatment, intravascular embolization and surgery Frequently an interdisciplinary team approach is needed.
authors: Azienda Ospedaliera Regionale San Carlo di Potenza, Unità Operativa Complessa di Chirurgia d'Urgenza, Potenza. ciro.de@tiscalinet.it
authors: Ciro
authors: C
authors: De Martino
authors: Antonio
authors: A
authors: Martino
authors: Rosa Maria
authors: RM
authors: Giamattei
authors: Gianfranco
authors: G
authors: Viola
authors: Anna
authors: A
authors: Pisapia
authors: Gennaro
authors: G
authors: Fatigati
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D001803:Blood Transfusion; D000077144:Clopidogrel; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000175:diagnosis* / Q000628:therapy*; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D017568:Rectus Abdominis / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine