title: Spontaneous haematoma of the anterior rectus abdominis muscle.
abstract: BACKGROUND
  Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous hematoma of the abdominal rectus muscle between March 2003 and December 2014.
  
  
  RESULTS
  The study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty- 8 patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolization. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage.
  
  
  CONCLUSIONS
  Spontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolization.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España. Electronic address: khoril@hotmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mendoza Moreno
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Díez Alonso
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Villeta Plaza
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Minaya Bravo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Enrique
authors.initials: E
authors.lastname: Ovejero Merino
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Diego Martín
authors.initials: DM
authors.lastname: Córdova García
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
authors.forename: Javier
authors.initials: J
authors.lastname: Granell Vicent
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017568:Rectus Abdominis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Anticoagulant therapy; Computed tomography; Diagnosis; Diagnóstico; Embolización arterial; Hematoma; Management; Rectus sheath; Terapia anticoagulante; Tomografía computarizada; Transcatheter embolization; Tratamiento; Vaina rectos