Tuberc Respir Dis.  2008 Sep;65(3):212-215.

A Case of Rectus Sheath Hematoma and Intraperitoneal Hematoma Induced by Cough

• Jeong HB
• Kang HH
• Im EJ
• Kim HG
• Lee SY
• Maeng IH
• Lee JM
• Jang EH
• Lee SH
• Moon HS

Abstract

Rectus sheath hematoma (RSH) is a rare condition that's caused by a sudden disruption of the deep epigastric vessels or direct damage to the rectus abdominis muscle. This condition is associated with old age, childbirth, abdominal surgery, severe cough, severe sneezing, anticoagulation therapy and/or coagulation disorders. RSH is characterized by abdominal pain and an abdominal mass, so that this is often misdiagnosed as a surgical condition such as appendicitis, intraabdominal abscess, torsion of the ovary and ruptured abdominal aortic aneurysm; this can lead to unnecessary surgery. Thus, we have to be cautious not to miss RSH when a patient with predisposing factors is suffered from abdominal pain and an abdominal mass. We report here on a case of rectus sheath hematoma that was induced by severe cough in a patient who was taking warfarin.

Keyword

Rectus abdominis; Hematoma; Cough; Warfarin

MeSH Terms

Abdominal Pain
Abscess
Appendicitis
Cough
Female
Hematoma
Humans
Muscles
Ovary
Parturition
Rectus Abdominis
Sneezing
Unnecessary Procedures
Warfarin
Warfarin

Figure

• 

  Figure 1 Initial abdominal computed tomography shows a hematoma measured 7.4×5.2 cm on right rectus abdominis muscle (A). It also reveals a mainly solid mass measured 8×6 cm on left pelvis (B) and a solid and cystic lesion measured 4×3 cm on right pelvis (C).

• 

  Figure 2 This photograph shows extensive bruise on the lower abdomen of the patient.

• 

  Figure 3 Abdominal computed tomography performed 2 weeks later shows rectus sheath hematoma decreased in size (5.2×2.8 cm).

Reference

1. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006. 85:105–110.

2. Linhares MM, Lopes Filho GJ, Bruna PC, Ricca AB, Sato NY, Sacalabrini M. Spontaneous hematoma of the rectus abdominis sheath: a review of 177 cases with report of 7 personal cases. Int Surg. 1999. 84:251–257.

3. Jung YG. Hematoma in the rectus sheath: report of two cases. J Korean Surg Soc. 1972. 14:55–57.

4. Kim JI, Cho SM. Two cases of rectus sheath hematoma after cesarean delivery. Korean J Obstet Gynecol. 1998. 41:3069–3072.

5. Park SH, Oh DR, Kim HK, Kim SK, Park SH. Spontaneous rectus sheath hematoma with hypovolemic shock. J Korean Soc Emerg Med. 2000. 11:586–591.

6. Yun HR, Yoo KD, Kim YJ, Yoo TS, Song SY, Jun JB. Rectus sheath hematoma complicated by rectus abdominus myonecrosis in a patient with rheumatoid arthritis. J Korean Rheum Assoc. 2007. 14:91–95.

7. Kwon KH, Park YH, Seo BJ, Lee BK, Choi JS, Kim YM, et al. A case of hematoma of anterior abdominal wall induced by severe cough. Korean J Intern Med. 1994. 47:563–569.

8. Son JH, Baik JJ, Yang KY, Ryu KW, Joo YJ, Choi SM, et al. A case of severe cough-induced abdominal wall hematoma. Tuberc Respir Dis. 2001. 51:462–465.

9. Chung YK, Son D, Lee SW, Um WH, Kim DY, Song JH, et al. Rectus muscle hematoma due to severe cough in CAPD patient. Korean J Nephrol. 2007. 26:788–791.

10. Zainea GG, Jordan F. Rectus sheath hematoma: their pathogenesis, diagnosis, and management. Am Surg. 1988. 54:630–633.

11. Cavagna E, Carubia G, Schiavon F. Anatomo-radiologic correlations in spontaneous hematoma of the rectus abdominis muscles. Radiol Med (Torino). 2000. 99:432–437.

12. Casey RG, Mahmoud M, Carroll K, Hurley M. Rectus sheath haematoma: an unusual diagnosis. Ir Med J. 2000. 93:90–92.

13. Edlow JA, Juang P, Margulies S, Burstein J. Rectus sheath hematoma. Ann Emerg Med. 1999. 34:671–675.

14. Berna JD, Garcia-Medina V, Guirao J, Garcia-Medina J. Rectus sheath hematoma: diagnostic classification by CT. Abdom Imaging. 1996. 21:62–64.

15. Fukuda T, Sakamoto I, Kohzaki S, Uetani M, Mori M, Fujimoto T, et al. Spontaneous rectus sheath hematoma: clinical and radiologic features. Abdom Imaging. 1996. 21:58–61.