What is a rectus sheath hematoma?

Rectus sheath hematoma (RSH) results from accumulation of blood within the rectus sheath. Both conditions are rare but may mimic a number of acute intra-abdominal pathologies, warranting heightened suspicion and prompting diagnostic evaluation and management [2].

When does rectus sheath hematoma occur?

Pregnancy is a risk factor in younger females, whereas males more commonly develop rectus sheath hematoma after trauma or muscular exertion. In a 1946 review of 100 cases, Teske reported the occurrence of rectus sheath hematoma in patients aged 4-83 years, with an average age of 47 years.

What causes rectus sheath Haematoma?

Predisposing factors associated with Rectus Sheath Haematoma formation are varied and include hypertension, arteriosclerosis, old age, obesity, direct abdominal trauma, anticoagulant therapy, previous abdominal surgery, pregnancy and acute intra-abdominal pressure fluctuations (straining, coughing, exertion) – the …

How is rectus sheath hematoma diagnosed?

The best diagnostic modality to evaluate a suspected RSH is an abdominal computerized tomography (CT) scan, which is more specific than ultrasonography. (Abdom Imaging 1996;21:62.) Sonographic findings are nonspecific in some cases, and can mimic abdominal wall tumors and inflammatory diseases.

How do you heal a rectus sheath hematoma?

Conservative treatment of rectus sheath hematoma includes rest; analgesics; hematoma compression; ice packs; treatment of predisposing conditions; and if necessary, more aggressive therapies of intravenous fluid resuscitation, reversal of anticoagulation, and transfusion.

How long does it take a rectus sheath hematoma to heal?

The majority of patients recover well with no complications as the hematoma is reabsorbed in 2 to 3 months. [6] In those with an indication for therapeutic anticoagulation, patients should be counseled on the risk for recurrence with the resumption of therapy.

Is a rectus sheath hematoma painful?

Although uncommon, rectus sheath hematoma is a significant cause of abdominal pain that can imitate surgical acute abdomen.

Is rectus sheath hematoma fatal?

Rectus sheath hematoma (RSH) is an uncommon and often misdiagnosed condition. This well-described entity is typically self-limited. In rare cases, the condition may be fatal.

Where is rectus sheath hematoma?

Rectus sheath hematoma usually occurs in the lower abdominal wall. Firm attachment of the branches of inferior epigastric artery while piercing the rectus abdominis and movement of the body creates shearing forces at arterial branch attachments.

How long does it take for a rectus sheath hematoma to heal?

Type I hematomas resolve after approximately 1 month. Type II hematomas require 2-4 months, and type III hematomas require more than 3 months and as long as a year for complete resolution.

What is the coding for a rectus sheath hematoma?

If it is Traumatic, then see S30.0 _ _ _ for Deep Contusion of the Abdomen/Abdominal wall. If it is Not Traumatic, but spontaneous, then see M79.81: Non-traumatic Hematoma of Soft-tissue or Muscle. However, this diagnosis implies some other underlying disease or bleeding disorder that should be identified and coded.

When to consider Spontaneous rectus sheath hematomas?

Conclusions: Spontaneous rectus sheath hematomas should be considered in the differential diagnosis of abdominal pain, particularly in elderly women under anticoagulant therapy with onset of symptoms after a bout of cough.

Can a rectus sheath hematoma cause abdominal pain?

Rectus sheath hematoma is an entity, accounting for less than 2% of patients complaining of acute abdominal pain and often clinically misdiagnosed cause of abdominal pain 2).

What causes a hematoma in the rectus abdominis muscle?

Rectus sheath hematoma occurs as a result of injury to an epigastric artery or its perforating branches within the rectus muscle. Recall that the blood supply to the rectus abdominis muscles originates from the superior and inferior epigastric arteries.