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Spontaneous rectus sheath hematoma: two variant cases.
Kamesh Sivagnanam1, Vatsal Ladia1, Vedang Bhavsar2
1Department of Internal Medicine at East Tennessee State University in Johnson City, Tennessee.
Summary
Spontaneous rectus sheath hematoma (SRSH) can occur in patients on anticoagulation or with underlying conditions. Early recognition and appropriate management, surgical or conservative, are crucial for favorable outcomes.
Area of Science:
- Medical Case Reports
- Internal Medicine
- Emergency Medicine
Background:
- Spontaneous rectus sheath hematoma (SRSH) is a rare but potentially serious condition.
- Increasing use of antithrombotic agents contributes to a potential rise in SRSH incidence.
- SRSH can present with diverse clinical manifestations and etiologies.
Purpose of the Study:
- To present two distinct cases of spontaneous rectus sheath hematoma.
- To highlight varied presentations and management strategies for SRSH.
- To emphasize the importance of clinician awareness regarding SRSH.
Main Methods:
- Case report of a 71-year-old woman with active bleeding SRSH managed surgically.
- Case report of a 64-year-old woman with non-bleeding SRSH managed conservatively.
- Review of clinical presentation, diagnostic imaging (CT), and treatment outcomes.
Main Results:
- Successful surgical evacuation of a large, actively bleeding SRSH in a patient on heparin therapy.
- Conservative management of a large SRSH in a patient with Wegener's Granulomatosis.
- Both patients demonstrated positive outcomes following their respective treatments.
Conclusions:
- SRSH management should be tailored to the clinical presentation, including active bleeding status.
- Clinicians must maintain a high index of suspicion for SRSH, considering both typical and atypical causes.
- Anticoagulant use and underlying inflammatory conditions are important considerations in SRSH etiology.
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