Conservative Treatment for Spontaneous Rectus Sheath Hematoma: A Case Report

Rectus sheath hematoma is a rare but clinically important cause of acute abdominal pain. In most cases, patients have a history of trauma or are taking antiplatelet or anticoagulant therapy. Spontaneous rectus sheath hematoma is even rarer, with atheromatous changes identified as a contributing factor in the elderly. A 100-year-old woman with a history of hypertension, chronic obstructive pulmonary disease, and congestive heart failure presented to our emergency department with sudden-onset abdominal pain and a large lower abdominal mass. She was not on anticoagulant treatment and denied any traumatic event or excessive strain on abdominal musculature such as a cough. A CT scan showed a hematoma involving the left anterior abdominal wall at the rectus sheath, extending into the lower abdomen. Subsequently, she was diagnosed with spontaneous rectus sheath hematoma. We started conservative treatment with hemostatic agents, namely, carbazochrome and tranexamic acid to control the expansion of bleeding. Her hemoglobin level and vital signs remained stable, and her symptoms improved significantly. A follow-up CT scan four days after admission revealed a reduction in the size of the hematoma. The patient's treatment course was uncomplicated, and she was eventually discharged on the sixth day of her admission. Rectus sheath hematoma is associated with a high morbidity and mortality rate in patients, especially those with additional comorbidities. Early diagnosis and sufficient supportive treatment are crucial for management. We suggest that carbazochrome and tranexamic acid are also effective therapies.