[Rectus sheath hematomas caused by acenocumarol overdose]

Acenocumarol is widely used in long-term anticoagulant treatment. Overdose of this drug may result in suffusions in various parts of the body. In three cases, we observed suffusion in the rectus sheath, which is an unusual site of hematomas. At early stage, the lack of discoloration of the abdominal wall may lead to problems in differential diagnosis. Chronic anticoagulant treatment in a patient's history in combination with a palpable abdominal mass facilitate the correct diagnosis. In addition, high INR also makes hemorrhagic complications more likely. In simple cases, suggestive past medical history, abdominal palpation, INR and ultrasound examination can be sufficient to make a diagnosis. However, in more complicated cases, further assessment by CT is required to set up the diagnosis; while, in a further case discussed in this article, we could only establish an accurate diagnosis with laparoscopy. Decreased plasma prothrombin levels were always normalized with vitamin K.