title: Rectus sheath haematoma: are there prognostic risk factors of haemodynamic instability motivating an early operative treatment?
abstract: OBJECTIVE
  Rectus sheath haematoma (RSH) is an uncommon condition caused by lesion of the superior or inferior epigastric arteries or their branches or by rupture of the rectus muscle. Treatment is usually supportive; however, if haemodynamic compromise develops, intravascular embolisation or surgery may be required. Furthermore, in some cases, bleeding may be so conspicuous that it can determine the patient's death before an adequate treatment is performed. We performed a retrospective study on 78 consecutive patients with the diagnosis of RSH admitted to the General Surgery Unit of our hospital between January 2000 and December 2010 in order to identify possible prognostic risk factors that could affect the operational approach before the onset of haemodynamic instability.
  
  
  METHODS
  Demographic characteristics, patient history, laboratory and diagnostic imaging examinations were investigated. The variables considered were: gender, age, anti-coagulation or anti-platelet therapy, trauma, international normalised ratio (INR) and bleeding time in the first 72 h of observation and concomitant diseases. The data were used for statistical analysis.
  
  
  RESULTS
  Sixty patients received a conservative treatment, while 18 underwent operative treatment for haemodynamic instability (embolisation in 2 patients and surgery in 16 patients). Three of these 18 patients (17 %) died for consumption coagulopathy after surgery. None of the variables included in the univariate statistical analysis was significant (p = ns).
  
  
  CONCLUSIONS
  Ultrasonography or computed tomography are the most common methods used to establish the diagnosis of RSH, so it is no longer a diagnostic dilemma. Most patients can be treated conservatively and an operative treatment is justified only in case of haemodynamic instability. Our retrospective study could not identify any prognostic risk factor of haemodynamic instability in RSH. We believe that only a close observation of the patients with RSH and "common sense" can prevent a possible fatal outcome.
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Villa
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Grande
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Rulli
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Konda
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Perretta
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Amabile
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy. Mauro.montuori@hotmail.it.
authors.forename: M
authors.initials: M
authors.lastname: Montuori
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Giurioli
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Simonetti
authors.affiliation: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tucci
keywords: Acute abdomen; Haemodynamic instability; Rectus sheath haematoma (RSH); Risks of the anti-coagulant/anti-platelet therapy
references.citation: Blood Coagul Fibrinolysis. 2005 Apr;16(3):217-9
references.pmid: 15795543
references.citation: Am Surg. 2003 Nov;69(11):975-7
references.pmid: 14627259
references.citation: Ann R Coll Surg Engl. 2007 Apr;89(3):309-12
references.pmid: 17394721
references.citation: Medicine (Baltimore). 2006 Mar;85(2):105-10
references.pmid: 16609349
references.citation: Ulus Travma Acil Cerrahi Derg. 2007 Jan;13(1):55-9
references.pmid: 17310412
references.citation: Rev Esp Enferm Dig. 1993 Mar;83(3):213-4
references.pmid: 8489819
references.citation: Emerg Med J. 2005 Jul;22(7):523-4
references.pmid: 15983097
references.citation: JAMA. 1983 Feb 18;249(7):924-5
references.pmid: 6218315
references.citation: Ulus Travma Acil Cerrahi Derg. 2010 Nov;16(6):532-6
references.pmid: 21153947
references.citation: World J Surg. 2006 Nov;30(11):2050-5
references.pmid: 17058030
references.citation: Br J Surg. 1997 Sep;84(9):1295-7
references.pmid: 9313718
references.citation: Vasc Med. 2008 Nov;13(4):275-9
references.pmid: 18940904
references.citation: AJR Am J Roentgenol. 1980 Dec;135(6):1283-4
references.pmid: 6450521
references.citation: Surg Endosc. 1999 Nov;13(11):1129-34
references.pmid: 10556453
references.citation: N Engl J Med. 1999 Jan 7;340(1):61-2
references.pmid: 9882216