Rectus sheath hematomas: their pathogenesis, diagnosis, and management

Rectus sheath hematomas are an uncommon entity causing an abdominal pain that may mimic other serious intraabdominal conditions. Knowledge of its predisposing factors and presentation are paramount in making the diagnosis. To facilitate the understanding of this condition, the authors reviewed their experience at St. Joseph Mercy Hospital in Ann Arbor, Michigan for the period between 1977 and 1986. Eight patients who were hospitalized for other reasons were found to have rectus sheath hematomas. All patients were women with an age range of 26 to 85 years and a mean age of 58 years. The correct diagnosis was made clinically in four patients. In those in whom hematomas of the rectus sheath were not initially diagnosed, surgery was undertaken, at which time the condition was identified. Predisposing factors include trauma, childbirth, previous operation of the lower abdomen, and anticoagulant use. Ultrasonography may aid in the diagnosis but CT scan is most accurate in its ability to define the lesion. When diagnosed clinically, a conservative therapeutic program can usually be instituted.