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Spontaneous Rectus Sheath Hematoma.
Snehasis Das1, Sagar Prakash1, Shweta Singh2
1Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Cureus
|September 27, 2023
Summary
Rectus sheath hematoma (RSH) is a surgical emergency presenting as acute abdominal pain. This case highlights a spontaneous RSH in a 51-year-old female, leading to fatal acute respiratory distress syndrome (ARDS).
Area of Science:
- Emergency Medicine
- Radiology
- Vascular Surgery
Background:
- Rectus sheath hematoma (RSH) is a critical surgical emergency often mimicking other acute abdominal conditions.
- RSH typically occurs in elderly patients, post-trauma, or with conditions like anticoagulation therapy, pregnancy, chronic cough, and liver disease.
- Spontaneous RSH without predisposing factors can occur.
Observation:
- A 51-year-old female presented with sudden abdominal pain, distention, hypotension, and pallor, suggestive of RSH.
- Radiological imaging indicated an RSH with active bleeding, potentially from the inferior epigastric or profunda femoris artery.
- The patient underwent digital subtraction angiography and angioembolization of a profunda femoris branch.
Findings:
- Despite interventional radiology, the patient's condition deteriorated.
- The patient ultimately succumbed to acute respiratory distress syndrome (ARDS).
Implications:
- This case underscores the potential severity and rapid progression of spontaneous RSH.
- It highlights the importance of prompt diagnosis and interventional management in RSH.
- The case also emphasizes the risk of fatal complications like ARDS, even with treatment.
