Rectus Sheath Hematoma in a Medical Ward: Case-Series
DOI:
https://doi.org/10.24950/SC/175/19/1/2020Keywords:
Anticoagulants, Hematoma, Rectus AbdominisAbstract
Introduction: Rectus sheath hematoma is a rare entity and seldomly the cause of acute abdominal pain. Although mostly benign, it can be fatal especially in older anticoagulated patients. We aim to study the occurrence and clinical presentation of this entity, focusing on its relationship with anticoagulant therapy.
Material and Methods: Retrospective case series of patients admitted to an Internal Medicine Unit of a tertiary university hospital and revision of the literature. Patients with the diagnosis of rectus sheath hematoma from 2010 to 2018 were included.
Results: In the study period, there were nine cases of rectus sheath hematoma in 14 730 admissions, with median age of 78 ± 9 years, of which 6 were women. All patients presented with spontaneous rectus sheath hematoma. Forty-four percent were severe, according to the Classification of Berná, and the mortality rate was 11%. Abdominal pain and a fall in the haemoglobin level (mean of 3.7 ± 1.8 g/dL) were the most common clinical manifestations and diagnosis was confirmed by computed tomography. All patients were under anticoagulants. Those treated with dicoumarins had a supratherapeutic INR (mean 6.0 ± 2.6) and a precipitating factor (cough), contrary to those under low-molecular weight heparin. Anticoagulation was reversed in 6 cases. Five patients were discharged under anticoagulants and had no rectus sheath hematoma recurrence.
Discussion/Conclusion: Rectus sheath hematoma must be considered in the differential diagnosis of patients with abdominal pain under anticoagulant therapy. Although a rare complication, it can have a fatal outcome. Efforts to guarantee a correct administration of low-molecular weight heparin, rigorous INR control and high clinical suspicion with early diagnosis are nec- essary to avoid it.
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