title: An Unusual Complication of EVAR, Spontaneous Rectus Sheath Hematoma: A Case Report.
abstract: OBJECTIVE
  To report a successful conservative management in a case of spontaneous rectus sheath hematoma (SRSH) after Endovascular Aneurysmal Repair (EVAR) of infrarenal Abdominal Aortic Aneurysm (AAA).
  
  
  METHODS
  An 84-year-old woman with a 6 cm in diameter infrarenal AAA underwent EVAR at our hospital. During the procedure, intravenous heparin was administered to keep the activated clotting time around 300 seconds. One hour after the procedure, the patient complained of pain on her right side abdomen. Physical examination revealed a tender mass in the right lower abdominal wall. Laboratory studies showed a fall in hemoglobin from 12.7 g/dl to 9.3 g/dl. Ultrasound (US) examination demonstrated an 8 × 5 cm hematoma within the right rectus muscle. Follow-up US examination revealed that the hematoma had enlarged and a computed tomography (CT) examination of the lower abdomen was performed. CT scan showed a smooth-shaped mass within the layers of the anterolateral abdominal wall leading to enlargement of the right rectus abdominis muscle without signs of active bleeding. A conservative management was considered.
  
  
  RESULTS
  The clinical course was uneventful with a stable hemodynamic state. The patient was discharged 12 days later and was doing well at the 2 week follow-up.
  
  
  CONCLUSIONS
  Spontaneous rectus sheath hematoma is an unusual complication of a patient on anticoagulant therapy during EVAR. A prompt radiological investigation may prevent unnecessary surgical procedures in this unusual complication.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Chiang Mai University Hospital, Chiang Mai, 50100, Thailand.
authors.forename: Kamphol
authors.initials: K
authors.lastname: Laohapensang
authors.forename: Chusak
authors.initials: C
authors.lastname: Sirivanichai
keywords: abdominal wall; anticoagulation therapy; endovascular; hemorrhage
references.citation: Surgery. 1972 Oct;72(4):568-72
references.pmid: 4262578
references.citation: Mayo Clin Proc. 1981 Dec;56(12):757-61
references.pmid: 6458745
references.citation: South Med J. 1980 Aug;73(8):969-70
references.pmid: 7403932
references.citation: Eur J Vasc Endovasc Surg. 2000 Jan;19(1):94-5
references.pmid: 10706846
references.citation: Eur Radiol. 1998;8(4):550-2
references.pmid: 9569320
references.citation: Abdom Imaging. 1996 Jan-Feb;21(1):62-4
references.pmid: 8672975
references.citation: Abdom Imaging. 2000 May-Jun;25(3):230-4
references.pmid: 10823439
references.citation: Surg Today. 2000;30(8):764-7
references.pmid: 10955746
references.citation: Am Surg. 1988 Oct;54(10):630-3
references.pmid: 2972238
references.citation: Br J Surg. 1977 Sep;64(9):633-4
references.pmid: 145260
references.citation: Am J Gastroenterol. 2000 Nov;95(11):3327-8
references.pmid: 11095381
references.citation: Chest. 2001 Jan;119(1 Suppl):108S-121S
references.pmid: 11157645