[Hematomas of the rectus abdominis muscle. 27 cases]

A series of 27 haematomas of the rectus abdominis muscle is reported; 10 occurred under anticoagulants, 6 were spontaneous, 5 followed a trauma, and 6 were consecutive to a surgical procedure. The clinical picture was subacute in 20 cases, with abdominal pain and extensive ecchymosis, acute in 4 cases, and reduced to an abdominal mass in 3 cases. Since 1977, ultrasonography has been of considerable help in the diagnosis, which was found to be accurate in 5 out of the 10 cases seen before its introduction, and in 13 out of the 14 cases where it was used among the 17 cases recorded later. Nineteen patients were operated upon for the following reasons: 4 for cardiovascular collapse, 3 because no diagnosis had been made, 8 in order to confirm the diagnosis, 1 because of an increase in size of the haematoma and 3 owing to infection. In the 8 patients who did not undergo surgery, the haematoma followed a favourable course. The therapeutic approach must be chosen according to the patient's condition and to the size, side effects and course of the haematoma.