Rectus sheath hematoma causing cecal perforation: a case report
Abanoub Awad1, Mitchell Meagher1, Isaac Theerman1
1Department of Surgery, Mayo Clinic Health System, 1400 Bellinger St. Eau Claire, WI 54703, United States.
Journal of Surgical Case Reports
|July 18, 2025
Summary
A rare rectus sheath hematoma, potentially linked to COVID-19, caused cecal perforation in a patient. Prompt diagnosis and intervention, including surgery, were crucial for survival.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Infectious Disease
Background:
- Rectus sheath hematoma (RSH) is a rare condition, often linked to trauma or anticoagulation.
- The incidence of RSH is estimated at 1.2-1.5 cases per year.
- COVID-19 infection has been associated with various thrombotic and inflammatory complications.
Observation:
- A 49-year-old male with a history of smoking and recent COVID-19 presented with respiratory symptoms and suspected venous thromboembolism.
- Imaging revealed bilateral pulmonary emboli and a left rectus sheath hematoma.
- The patient developed worsening anemia, encephalopathy, and abdominal pain, indicating complications.
Findings:
- The rectus sheath hematoma enlarged, necessitating transfusion and selective embolization.
- Hollow viscus perforation was confirmed, specifically a cecal perforation.
- The perforation was attributed to the mass effect of the expanding hematoma.
Implications:
- This case highlights a rare but severe complication of rectus sheath hematoma, including hollow viscus perforation.
- It underscores the importance of considering abdominal complications in patients with risk factors and recent infections.
- Management may require a multidisciplinary approach involving interventional radiology and surgery.
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