Rectus sheath haematoma following emergency caesarean section: diagnosis and management

Rectus sheath haematoma is a rare condition characterised by bleeding within the rectus abdominis muscle sheath. While often self-limiting, large haematomas may result in significant morbidity and require prompt intervention. A woman in her mid-20s with severe pre-eclampsia underwent an emergency caesarean section. Postoperatively, she developed severe abdominal pain and a palpable right-sided mass. Imaging revealed a large Type III rectus sheath haematoma extending from the hypochondrium to the pelvis. Surgical exploration evacuated a 600-mL haematoma, and bleeding was controlled by ligating the inferior epigastric artery. She remained asymptomatic during follow-up. Rectus sheath haematoma after caesarean section is uncommon but potentially life-threatening. CT imaging is critical for diagnosis and classification. Management depends on haemodynamic stability, with surgical intervention indicated in large or complicated haematomas. Diligent postoperative monitoring and early recognition and intervention in postoperative rectus sheath haematoma are essential for ensuring favourable outcomes.