[Rectus sheath hematoma]

Rectus sheath hematoma is rarely diagnosed preoperatively. It can mimic acute intra-abdominal disease and other familiar disorders. It is more frequent during pregnancy and debilitating diseases. Blunt trauma to the abdomen, straining, coughing and anticoagulant therapy are also common contributing factors. The presenting symptom is onset of acute, localized, abdominal pain soon after the precipitating event. A tender abdominal mass is palpated in one of the rectus muscles. There are no specific diagnostic laboratory tests. Ultrasonography is the procedure of choice for correct diagnosis. Most of these patients can be successfully managed conservatively. During a period of two years, five cases were treated. Three of the patients suffered from acute cough associated with upper respiratory infections. Two had had multiple childbirths, one had had an abdominal operation and another had Cushing's disease and morbid obesity. Three were misdiagnosed and operated on. The hematoma was evacuated but the peritoneum was not opened. In two patients the correct diagnosis was made by ultrasonography and they were successfully treated conservatively.