J Korean Soc Emerg Med.  2000 Dec;11(4):586-591.

Spontaneous Rectus Sheath Hematoma with Hypovolemic Shock

• Park SH
• Oh DR
• Kim HK
• Kim SK
• Park SH

Abstract

Rectus sheath hematoma of the abdominal wall is a well-recognized, but uncommon condition, caused by a tear in an epigastric vessel and characterized by sudden onset of severe abdominal pain and palpable mass. In most cases, a precipitating cause can be demonstrated. Causes include external trauma, strenuous activities, coughing, lifting, sneezing, vomiting, straining while urinating or defecating, golfing, pregnancy and the puerperium, anticoagulation therapy, infection, chronic diesase, arteriosclerosis, hypertension, prior paracentesis or laparotomy, inadequate hemostasis or excessive retraction in surgery, and idiopathy. Unfortunately, the correct diagnosis often is missed, and the hematoma is found only during an exploratory laparotomy. Treatment should be conservative in most instances. Although the mortality rate for patients with rectus sheath hematoma is low, the condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed. Hence, it should be included in the differential diagnosis of any patient who presents to the emergency department with acute onset of abdominal pain. Our purpose is to familiarlize emergency physicians with the pathophysiology, the diagnosis, and the treatment of rectus sheath hematoma. We describe a patient with fatal rectus sheath hematoma presenting to the emergency department and give a review of the literature.

MeSH Terms

Abdominal Pain
Abdominal Wall
Arteriosclerosis
Cough
Diagnosis
Diagnosis, Differential
Emergencies
Emergency Service, Hospital
Golf
Hematoma*
Hemorrhage
Hemostasis
Humans
Hypertension
Hypovolemia*
Laparotomy
Lifting
Mortality
Paracentesis
Postpartum Period
Pregnancy
Shock*
Sneezing
Vomiting