Acute obstructive uropathy secondary to a rectus sheath haematoma in an anticoagulated patient

A rectus sheath haematoma (RSH) is a relatively rare cause of acute abdominal pain that is becoming more prevalent due to an increase in anticoagulant therapy. Of its associated complications, acute obstructive uropathy is exceedingly rare. This is a case of a 62-year-old lady who presented with abdominal pain caused by an RSH which then led to obstructive uropathy. She had undergone laparoscopic removal of a gastric band 6 days prior and due to a mechanical mitral valve, required ongoing anticoagulation. Initially, she had a contained RSH, but this subsequently decompressed into the extraperitoneal space, causing acute obstructive uropathy secondary to external compression. She was managed with ureteric stenting and her anticoagulation was appropriately modified throughout her admission. This case highlights that the challenging aspect of RSH management involves tailoring treatment to address individual patient factors and the location of the haematoma itself.