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[Spontaneous rectal hematoma]

K H Andreassen1, T E Olesen, P T Jacobsen

  • 1Kirurgisk afdeling K, Bispebjerg Hospital, København.

Ugeskrift for Laeger
|April 15, 1996
PubMed
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Spontaneous rectus sheath hematomas are rare, often affecting women and linked to factors like coughing or anticoagulants. Early diagnosis via clinical findings and ultrasonography is key for conservative treatment.

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).

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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.