Rectus sheath haematoma (RSH) mimicking acute intra-abdominal pathology

Rectus sheath haematoma (RSH) is a rare cause of acute abdomen. We present a case series of patients seen at Wanganui Hospital, North Island, New Zealand.

A retrospective survey of patients developing RSH over a 2-year period (from 2002 to 2004) in our hospital was carried out.

Seven patients were identified with RSH (male:female ratio=6:1, age range=16-80 years). Six of the RSH were spontaneous and four out of these six were on anticoagulant therapy post-acute coronary event. Each presented with acute abdomen and all were missed on initial evaluation. Two were diagnosed initially as bowel obstruction, one as acute diverticulitis, one as incarcerated hernia, one as an ovarian mass, and another as non-specific abdominal pain. One patient had traumatic RSH with peritonitis secondary to accompanying jejunal perforation. The ultrasound pick-up rate was 50% of but computed tomography (CT) abdomen was 100% diagnostic. Five (70%) had a significant fall in haematocrit, requiring blood transfusion. All settled on conservative management, with one requiring admission to intensive care.

Clinical diagnosis of RSH is unreliable. CT imaging is the procedure of choice and should be promptly carried out especially in those on anticoagulant therapy for early diagnosis and proper management.