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Small bowel infarction complicating rectus sheath haematoma in an anticoagulated patient
Robert A Dineen1, Nina R Lewis, Nishath Altaf
1Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.
Background:
A rectus sheath haematoma is a difficult condition to diagnose and is usually treated by conservative measures. However, significant sized haematomas can result in severe haemodynamic repercussions, especially in those patients with co-morbidities and anticoagulation.
Case Report:
The case reported here is of a 68 year old anticoagulated patient with severe medical co-morbidity who presented with abdominal pain and hypotension. An abdominal CT scan demonstrated a large rectus sheath haematoma and small bowel infarction. The relationship between these two separate causes of an acute abdomen is discussed and imaging findings are illustrated.
Conclusions:
A careful history and a high index of suspicion are necessary to diagnose a rectus sheath haematoma. Further imaging such as CT may be required and if diagnosed early enough, it should be treated aggressively based on the clinical findings.
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