[Spontaneous rectal hematoma]

Area of Science:

• Abdominal Surgery
• Diagnostic Imaging
• Emergency Medicine

Background:

• Spontaneous rectus sheath hematoma (SRSH) is an uncommon condition, often presenting as acute abdominal pain.
• Factors contributing to SRSH include anticoagulant therapy, strenuous physical activity, and conditions causing increased intra-abdominal pressure.
• The condition's rarity and varied presentation can lead to diagnostic challenges.

Observation:

• This report details five cases of SRSH observed over one year, with a female predominance (4:1) and an age range of 26-75 years.
• Precipitating factors included cough (3 cases) and physical exercise (1 case), with potential predisposing factors like anticoagulant therapy, Addison's disease, and abdominal scars noted.
• Hematomas were located in the lower right quadrant (3 cases), lower left (1 case), and upper right (1 case).

Findings:

• Correct clinical diagnosis, confirmed by ultrasonography, led to conservative management in three cases.
• In two cases, clinical suspicion was low, resulting in delayed diagnosis; one hematoma was missed by ultrasonography, and another was misinterpreted as an intraperitoneal tumor, necessitating surgery.
• The estimated incidence rate of SRSH is 3.5 per 100,000 person-years, representing approximately 0.9% of patients admitted with acute abdomen.

Implications:

• Accurate and timely diagnosis of SRSH is crucial for appropriate management, distinguishing between conservative and surgical approaches.
• Ultrasonography is a valuable tool, but diagnostic errors can occur, highlighting the importance of integrating clinical suspicion with imaging findings.
• Increased awareness of SRSH among clinicians is necessary, particularly in patients presenting with acute abdominal pain and relevant risk factors.