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Spontaneous rectus sheath hematoma associated with warfarin administration: a case report
Koji Takahashi1, Takeshi Nihei1, Yohei Aoki1
1Department of Gastroenterology, Mito Saiseikai General Hospital, Japan.
Journal of Rural Medicine : JRM
|December 3, 2019
Summary
Spontaneous rectus sheath hematoma (RSH) is rare, especially without trauma. This case highlights RSH in a patient on warfarin for chronic thromboembolic pulmonary hypertension (CTEPH), emphasizing the need for clinical suspicion.
Area of Science:
- Medicine
- Cardiology
- Radiology
Background:
- Rectus sheath hematoma (RSH) typically results from trauma or muscle injury.
- Spontaneous RSH is uncommon, particularly in patients without a history of abdominal trauma.
Purpose of the Study:
- To report a rare case of spontaneous rectus sheath hematoma (RSH).
- To highlight the association between warfarin use for chronic thromboembolic pulmonary hypertension (CTEPH) and spontaneous RSH.
- To emphasize the importance of considering RSH in patients on anticoagulation presenting with abdominal pain.
Main Methods:
- Case report of an 87-year-old female patient with abdominal pain, nausea, and vomiting.
- Diagnostic imaging using abdominal computed tomography (CT) scan to identify RSH.
- Management included warfarin antagonism with vitamin K and administration of hemostatic agents.
Main Results:
- Abdominal CT confirmed a right-sided rectus sheath hematoma.
- The patient's symptoms improved with medical management.
- Follow-up CT scan showed a significant reduction in hematoma size.
Conclusions:
- Spontaneous RSH should be considered in patients on warfarin therapy presenting with abdominal pain, even without trauma.
- Prompt diagnosis and management are crucial for favorable outcomes.
- Warfarin therapy, used for conditions like CTEPH, may increase the risk of spontaneous RSH.
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