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Updated: Jul 15, 2025

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
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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.

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|September 27, 2023
PubMed
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).

Keywords:
angioembolizationdigital subtraction angiographyinferior epigastric arteryprofundal femoris arteryrectus sheath hematoma

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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.