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[Spontaneous hematoma of the abdominal wall: diagnostic error of abruptio placentae]
H Brühwiler1, M Krause, A Szoenyi
1Frauenklinik, Thurgauisches Kantonsspital, Münsterlingen.
An emergency cesarean section was performed in the 38th week of pregnancy in a patient with acute abdominal pain in the left upper quadrant. The ultrasound picture was interpreted as a retroplacentar hematoma. Cardiotocography demonstrated fetal tachycardia which was interpreted as asphyxia. A diagnosis of abruptio placentae was made, but was finally ruled out when the cesarean section was performed. The intraabdominal exploration revealed a large hematoma of the rectus sheath with about 800 ml of blood. After evacuation and drainage the postoperative recovery was uneventful. Sudden rupture of a deep epigastric vessel with formation of an abdominal wall hematoma also mimics intraabdominal conditions such as appendicitis, diverticulitis, cholecystitis, tumours and visceral injuries.
An emergency cesarean section was performed in the 38th week of pregnancy in a patient with acute abdominal pain in the left upper quadrant. The ultrasound picture was interpreted as a retroplacentar hematoma. Cardiotocography demonstrated fetal tachycardia which was interpreted as asphyxia. A diagnosis of abruptio placentae was made, but was finally ruled out when the cesarean section was performed. The intraabdominal exploration revealed a large hematoma of the rectus sheath with about 800 ml of blood. After evacuation and drainage the postoperative recovery was uneventful. Sudden rupture of a deep epigastric vessel with formation of an abdominal wall hematoma also mimics intraabdominal conditions such as appendicitis, diverticulitis, cholecystitis, tumours and visceral injuries.