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Rectus sheath haematoma following exercise testing: a case report
Laszlo Barna1, Imre Toth, Erzsebet Kovacs
1Department of Cardiology and Internal Medicine, Borsod County Hospital and Teaching Hospital, Miskolc, Szentpéteri kapu, Hungary. lbarna68@t-online.hu.
Insights
Rectus sheath hematoma is a rare complication of exercise testing, particularly in patients with acute coronary syndrome. This case highlights the importance of assessing bleeding risk before the procedure to prevent serious complications.
Area of Science:
- Cardiology
- Diagnostic Procedures
- Gastroenterology
Background:
- Exercise testing is a standard diagnostic tool for coronary heart disease.
- Complications are typically cardiac, but non-cardiac events can occur.
- Rectus sheath hematoma is a rare but serious complication.
Purpose of the Study:
- To report the first case of rectus sheath hematoma following exercise testing.
- To highlight a rare complication of a common diagnostic procedure.
- To emphasize the need for bleeding risk assessment.
Main Methods:
- A case report of a 72-year-old woman with acute coronary syndrome.
- The patient underwent exercise testing and subsequently developed abdominal pain.
- Investigations revealed a rectus sheath hematoma requiring surgical intervention.
Main Results:
- A rectus sheath hematoma was diagnosed after exercise testing in a patient with acute coronary syndrome.
- The patient required surgical evacuation and re-operation due to recurrent bleeding.
- The patient had risk factors for bleeding associated with her acute coronary syndrome treatment.
Conclusions:
- Rectus sheath hematoma is a potential complication of exercise testing.
- Pre-procedure bleeding risk assessment is crucial for patient safety.
- Avoiding excessive anticoagulation can help prevent this complication.
Introduction:
Exercise testing is a safe diagnostic procedure which is widely used in the evaluation of patients suspected of having coronary heart disease or for the assessment of the prognosis in patients with established disease. Its complications are mainly cardiac disorders. Here, we report a rectus sheath haematoma as a complication of this procedure in a patient with acute coronary syndrome. To our knowledge, this is the first case report of rectus sheath haematoma in association with exercise testing.
Case Presentation:
A 72-year-old Caucasian woman was admitted for acute coronary syndrome. She received conservative treatment including low molecular weight heparin and anti-platelet agents. On the fifth day of her hospital stay, she underwent an exercise test, where no ischaemic response occurred. Several hours later, she experienced pain in the left side of her abdomen. Subsequent investigations revealed a rectus sheath haematoma. The patient underwent surgical haematoma evacuation. A few days later, re-operation was performed for recurrent bleeding in the abdominal wall. The patient had several characteristics known to increase the risk of bleeding during treatment for acute coronary syndrome.
Conclusion:
Awareness of this possible consequence of exercise testing is important for preventing and treating it correctly. For prevention, an assessment of the bleeding risk of the individual patient is necessary before the test, and excessive anticoagulation must be avoided.
