Cough-induced rectus sheath hematoma in an adolescent without external abdominal findings: a case report

Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that predominantly affects older, anticoagulated adults and usually presents with a palpable abdominal-wall mass. We report a 17-year-old previously healthy male who developed midline lower abdominal pain after 6 days of severe coughing, without anticoagulation, trauma, or bleeding disorder, and with no visible swelling, ecchymosis, or palpable mass; Carnett's sign was positive. Ultrasonography, magnetic resonance imaging, and contrast-enhanced computed tomography confirmed a hematoma confined to the lower rectus sheath without active extravasation, and he recovered fully with conservative management. In a review of recent cough-induced RSH reports, all prior patients had a predisposing condition or external abdominal findings; our patient is the youngest reported and had neither. RSH should be considered in adolescents with persistent abdominal pain after severe coughing, even when examination is unremarkable.