title: Evaluation of Risk Factors for Rectus Sheath Hematoma.
abstract: Rectus sheath hematoma (RSH) develops due to rupture of epigastric arteries or the rectus muscle. Although RSH incidence rate is low, it poses a significant diagnostic dilemma. We evaluated the risk factors for RSH, its presentation, management, and outcomes for 115 patients hospitalized with confirmed RSH by computed tomography scan between January 2005 and June 2009. More than three-fourth (77.4%) of the patients were on anticoagulation therapy, 58.3% patients had chronic kidney disease (CKD) stage ≥3, 51.3% had abdominal injections, 41.7% were on steroids/immunosuppressant therapy, 37.4% had abdominal surgery/trauma, 33.9% had cough, femoral puncture was performed in 31.3% of patients, and 29.5% were on antiplatelet therapy. Rectus sheath hematoma was not an attributable cause in any of the 17 deaths. Mortality was significantly higher in patients with CKD stage ≥3 (P = .03) or who required transfusion (P = .007). Better understanding of RSH risk factors will facilitate early diagnoses and improve management.
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA hss2@pitt.edu.
authors.forename: Heena S
authors.initials: HS
authors.lastname: Sheth
authors.affiliation: Hematology/Oncology Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Kumar
authors.affiliation: CV Division, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA.
authors.forename: Jeannine
authors.initials: J
authors.lastname: DiNella
authors.affiliation: Risk Management, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Janov
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Hoda
authors.initials: H
authors.lastname: Kaldas
authors.affiliation: Hematology/Oncology Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Roy E
authors.initials: RE
authors.lastname: Smith
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D019074:Epigastric Arteries / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D017568:Rectus Abdominis / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality
chemical_list: D000925:Anticoagulants; D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors
keywords: anticoagulants; bleeding; heparins; renal failure