Although the etiology includes trauma, abdominal operations, trocar site injury after laparoscopic operations, subcutaneous drug injections, anticoagulant therapy, hematological diseases, coughing, physical exercise, and pregnancy, it rarely occurs spontaneously [5, 6].

What causes a rectus sheath hematoma?

Rectus sheath hematomas (RSHs) are generally caused either by rupture of one of the epigastric arteries or by a muscular tear with shearing of a small vessel.

Is rectus sheath hematoma common?

Rectus sheath hematoma is an uncommon, but not rare, cause of abdominal pain. In 1999, Klingler et al found an incidence of 1.8% among 1257 patients admitted to the hospital with abdominal pain and undergoing ultrasonography for diagnosis. Anticoagulation is a well-known risk factor.

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.

What causes a hematoma in the abdomen?

Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They result from rupture of the epigastric vessels or the deep circumflex iliac artery (rarely), or from tears of the fibers of the rectus abdominis or lateral oblique muscles [1,2].

How painful is a rectus sheath hematoma?

The typical presentation of a rectus sheath hematoma is abdominal pain and its associated symptoms like nausea and vomiting. The pain is often sudden in onset, sharp, and does not radiate. In extremely rare cases, the hematoma may be large and present with hypovolemia, tachycardia, and tachypnea.

What is found in the rectus sheath?

The rectus sheath is the durable, resilient, fibrous compartment that contains both the rectus abdominis muscle and the pyramidalis muscle. The fascial coverings of the external oblique, internal oblique, and transversus abdominis muscles comprise the rectus sheath.

What are the symptoms of a rectus sheath hematoma?

Rectus sheath hematomas most often present as acute onset of abdominal pain with a palpable abdominal mass. Additional findings may include fevers, chills, nausea, vomiting, abdominal tenderness, and abdominal guarding.

How is rectus sheath hematoma treated?

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.

What is a rectus sheath hernia?

Rectus sheath hernias (alternative plural: herniae) are a very seldom seen form of herniation through the anterior abdominal wall. Herniation of intra-abdominal contents (mesenteric fat +/- bowel), is usually through the posterior rectus sheath only and thus these are often termed posterior rectus sheath hernias.

Where is a 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.

What does the rectus sheath do?

The function of the rectus sheath is to protect the muscles and vessels which it encloses. In addition, keeping the rectus abdominis and pyramidalis muscle together helps in providing maximal compression of and support to abdominal viscera.

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.

Can a hematoma cause death?

An enlarging hematoma can cause gradual loss of consciousness and possibly death. The three types of subdural hematomas are: Acute. This most dangerous type is generally caused by a severe head injury, and signs and symptoms usually appear immediately.

Which of the following may cause a hematoma?

The most common cause of a hematoma is injury or trauma to blood vessels. This can happen as a result of any damage to blood vessels that can disrupt the integrity of the blood vessel wall. Even minimal damage to a small blood vessel can result in a hematoma.

When should you worry about a hematoma?

If a hematoma is especially painful, it is best to seek medical attention. A doctor can provide tips on wrapping or bracing the area. It is also a good idea to see a doctor if the area shows signs of infection, such as discoloration, swelling, and feeling warm to the touch.