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Cureus 2021 May 6;13(5):e14870. Epub 2021 May 6.

General Surgery, Erzurum Regional Education and Research Hospital, Erzurum, TUR.

This case report presents a large left rectus sheath hematoma (RSH) case developed in a COVID-19 patient who had received no anticoagulant therapy before hospital admission. It discusses the patient's diagnosis and treatment process. A 78-year-old woman was admitted to the ED with acute cough and shortness of breath. Read More

J Coll Physicians Surg Pak 2021 Jun;30(6):633-637

Department of General Surgery, Medical School, Hitit University, Corum, Turkey.

Objective: To evaluate the risk factors for developing rectus sheath hematoma (RSH).

Study Design: An observational study.

Place And Duration Of Study: Department of General Surgery, Hitit University School of Medicine, Erol Olcok Training and Research Hospital, Turkey; from January 2018 to April 2020. Read More

Br J Haematol 2021 Jun 7. Epub 2021 Jun 7.

Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool Hospital, Liverpool, UK.

J Surg Case Rep 2021 May 27;2021(5):rjab180. Epub 2021 May 27.

Department of Surgery, Lismore Base Hospital, New South Wales 2480, Australia.

Rectus sheath haematoma (RSH) is an uncommon cause of abdominal pain. Despite being previously viewed as a benign, self-limiting condition, there is increasing evidence suggesting significant local and systemic complications with RSH. We present a case of an 82-year-old female who developed a large RSH following prescription of therapeutic anticoagulation for her new onset atrial fibrillation. Read More

BMJ Case Rep 2021 May 24;14(5). Epub 2021 May 24.

Internal Medicine, Hurley Medical Center, Flint, Michigan, USA

Indian J Surg 2021 May 8:1-7. Epub 2021 May 8.

Department of General Surgery, Medical College, Kashan, Iran.

Since venous microthrombotic and thromboembolic events in end organs have been pathophysiologically confirmed as a component of thrombo-inflammatory cascade in COVID-19 syndrome, anticoagulant prescription with prophylactic or therapeutic goal is recommended. Different guidelines for the above are introduced; however, there is no general consensus on any neither the type of anticoagulant nor for the dosage and duration of prescription. In our medical center, adopted internal guideline was considered for patients COVID-19. Read More

AME Case Rep 2021 25;5:16. Epub 2021 Apr 25.

West Virginia University School of Medicine, Morgantown, WV, USA.

Pregnancy, surgery, and trauma are known risk factors for the development of rectus sheath hematomas (RSHs). The exact incidence of RSH during pregnancy is unknown, however this disease carries a risk of complication and even mortality. The role of infection in this condition is less known with only a few reported case studies in medical literature. Read More

Am J Case Rep 2021 Apr 1;22:e931080. Epub 2021 Apr 1.

Indiana University School of Medicine South Bend Campus, Notre Dame, IN, USA.

BACKGROUND The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often manifests a coagulopathy in severely ill patients, which may cause hemorrhage and/or thrombosis of varying severity. This report comprises the cases of 3 patients with COVID-19-associated coagulopathy who were evaluated with thromboelastography (TEG) and activated partial thromboplastin time (aPTT) to enable personalized anticoagulant therapy. CASE REPORT Three patients presented with COVID-19 pneumonia, confirmed by reverse transcription-polymerase chain reaction, who developed thrombohemorrhagic coagulopathy. Read More

Surg Today 2021 Apr 17. Epub 2021 Apr 17.

Department of Surgery, Moriguchi-Keijinkai Hospital, 2-47-12 Yagumo-higashimachi, Moriguchi, Osaka, 570-0021, Japan.

Purpose: Abdominal incisional hernia is a frequent complication of major abdominal operations. Our method of performing mesh repair under the anterior lamina of the rectus sheath (MUAR) involves placing mesh between the dorsal surface of the anterior rectus sheath and the rectus abdominis muscle. We evaluated the short-term and long-term outcomes of our MUAR method. Read More

Clin Imaging 2021 Apr 14;79:12-19. Epub 2021 Apr 14.

Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion Street, Alexandria 21131, Egypt. Electronic address:

Purpose: To report imaging findings at computed tomography angiography (CTA) and venography (CTV) of the abdomen and pelvis in evaluation of hemorrhagic and thrombotic lesions in hospitalized patients with COVID-19.

Methods: In this retrospective observational study, patients admitted to a single tertiary care center from April 1 to July 20, 2020, who tested positive for SARS-CoV-2 and developed acute abdominal pain or decreasing hemoglobin levels over the course of hospitalization were included. Abdominal CTA/CTV imaging studies performed in these patients were reviewed, and acute hemorrhagic or thromboembolic findings were recorded. Read More

Cureus 2021 Mar 3;13(3):e13669. Epub 2021 Mar 3.

Emergency Medicine, Eskisehir Osmangazi University, Eskisehir, TUR.

Iatrogenic rectus sheath hematoma (RSH) developed after paracentesis is a rare but life-threatening complication. Mortality rates of patients may increase due to delays in treatment and comorbid conditions. In this article, we present the case of a patient who was unstable in the emergency department and was diagnosed with RSH using point-of-care ultrasonography (POCUS). Read More

Braz J Anesthesiol 2021 Mar 22. Epub 2021 Mar 22.

Ataturk Training and Research Hospital, Izmir Katip Celebi University, Department of Emergency Medicine, Izmir, Turkey.

Noninvasive mechanical ventilation (NIMV) has a relevant role in the treatment of critically ill patients displaying severe dyspnea. Continuous positive airway pressure (CPAP), a method of NIMV, is also widely used in the management of acute heart failure, chronic obstructive pulmonary disease (COPD) exacerbation, and symptomatic sleep apnea. However, numerous traumatic complications of CPAP treatment in the face region, head, and thorax have been reported and may be related to the application of a continuous positive high pressure to the airway. Read More

Radiol Case Rep 2021 May 24;16(5):1015-1018. Epub 2021 Feb 24.

Department of Radiology, Bolu Abant Izzet Baysal University, Bolu, Turkey.

Cough-related hematomas occur most frequently in the rectus sheath and retroperitoneum while lateral abdominal wall hematomas are rarely reported. Intramuscular hematoma might be mistaken for tumors and acute inflammatory diseases of the abdomen. A definite diagnosis is made with computerized tomography. Read More

Ulus Travma Acil Cerrahi Derg 2021 Mar;27(2):222-230

Department of General Surgery, Iğdır State Hospital, Iğdır-Turkey.

Background: Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management. Read More

Radiol Case Rep 2021 May 13;16(5):999-1004. Epub 2021 Feb 13.

Ascension Saint Michael's Hospital, Stevens Point, WI.

Multiple studies and reports have suggested that coronavirus disease-19 (COVID-19) promotes arterial and venous thrombotic events in multiple organ systems, although the mechanism leading to a hypercoagulable state is still unknown. Few cases of splenic infarction associated with COVID-19 have been reported, of which half were found incidentally upon autopsy. This may be due to a clinically silent presentation or the symptoms being wrongfully attributed to pain caused by the effects of COVID-19. Read More

Cureus 2020 Dec 18;12(12):e12156. Epub 2020 Dec 18.

General Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.

A rectus sheath hematoma (RSH) is a rare medical condition that consists of blood accumulating in the rectus abdominis muscle sheath. RSH is most frequently due to a hemorrhage from the superior or inferior epigastric artery. RSH has many specific risk factors, such as anticoagulant use. Read More

BMJ Case Rep 2021 Jan 19;14(1). Epub 2021 Jan 19.

Department of Interventional Radiology, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA.

A 26-year-old man presented with a 4-week history of right lower quadrant abdominal pain which was managed conservatively at home with ibuprofen. Three days later, he presented to the emergency department with worsening pain and swelling following an episode of coughing and slipping in the bathroom. Following his admission, CT angiography showed an active bleed into a 4. Read More

Thromb Res 2021 03 26;199:54-58. Epub 2020 Dec 26.

Univ Rennes, CHU Rennes, EA 7449 [Pharmacoepidemiology and Health Services Research] REPERES, F 35043 Rennes, France. Electronic address:

Background: There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants.

Objective: To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality.

Patients And Methods: Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated. Read More

Clin Case Rep 2020 Dec 27;8(12):3432-3439. Epub 2020 Oct 27.

UFC - Coimbra Regional Pharmacovigilance Unit CHAD - Centre for Health Technology Assessment and Drug Research AIBILI - Association for Innovation and Biomedical Research on Light and Image Coimbra Portugal.

Physicians must acknowledge the potential risk of RSH with enoxaparin. Switching home anticoagulation by enoxaparin upon hospital admission is common, but it may put patients at higher risk for RSH. Management guidelines are needed in this setting. Read More

Maedica (Bucur) 2020 Sep;15(3):412-415

Department of Surgery, Maulana Azad Medical College, New Delhi, India.

A 60-year old female presented to the emergency department with complaints of acute abdominal pain and lump in the right upper abdomen. Physical examination revealed a large tender abdominal lump in the right hypochondrium, extending up to the right lumbar region. Further examination revealed that the lump was parietal and not intra-abdominal. Read More

J Vasc Interv Radiol 2021 03 11;32(3):484-486. Epub 2020 Dec 11.

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Vasc Endovascular Surg 2021 Apr 14;55(3):221-227. Epub 2020 Dec 14.

Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK.

Purpose: Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches.

Methods: This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Read More

BMC Anesthesiol 2020 11 23;20(1):291. Epub 2020 Nov 23.

Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Background: We explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB).

Methods: This was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Read More

Radiographics 2020 Nov-Dec;40(7):2117-2141. Epub 2020 Oct 23.

From the Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.

The postpartum period, also known as the puerperium, begins immediately after delivery of the neonate and placenta and ends 6-8 weeks after delivery. The appearance of physiologic uterine changes during puerperium can overlap with that of postpartum complications, which makes imaging interpretation and diagnosis difficult. Obstetric and nonobstetric postpartum complications are a considerable source of morbidity and mortality in women of reproductive age, and the radiologist plays an important role in the assessment of these entities, which often require a multimodality imaging approach. Read More

Int J Surg Case Rep 2020 4;76:415-420. Epub 2020 Oct 4.

Imam Abdulrahman Alfaisal Hospital, Riyadh, Saudi Arabia. Electronic address:

Introduction: Management of COVID-19 pneumonia cases is a medical challenge. However, the situation becomes worse if the patient has coexisting morbidities or newly developed complications. The study is about managing rectus sheath haematoma (RSH) in a patient with COVID-19 pneumonia. Read More

Radiol Case Rep 2020 Oct 25;15(10):2022-2025. Epub 2020 Aug 25.

Department of Obstetrics & Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, United Kingdom.

This clinical study reports a case of rectus sheath hematoma in a 32-year-old woman with a pregnancy at 33 weeks of gestation, who developed acute right-sided abdominal pain following anticoagulant administration for pulmonary embolism. The rectus sheath hematoma was identified during an emergency cesarean section initiated due to severe fetal bradycardia. The present case would have been easy to manage prenatally if the presence of rectus sheath hematoma had been added as a differential diagnosis. Read More

Am J Health Syst Pharm 2020 Aug 20. Epub 2020 Aug 20.

Department of Pharmacy Services, Harper University Hospital, Detroit, MI.

Purpose: Three cases of major bleeding associated with thromboprophylactic unfractionated heparin (UFH) therapy in underweight neurocritically ill patients are reported.

Summary: Three underweight patients (body mass index of <18.5 kg/m2) were treated in the intensive care unit with major bleeds associated with UFH thromboprophylaxis. Read More

J Cardiothorac Vasc Anesth 2020 Dec 16;34(12):3367-3372. Epub 2020 Jul 16.

Department of Pediatric Anesthesiology, University Hospital Bonn, Bonn, Germany.

Systemic intravenous administration of opioids is the main treatment strategy for intraoperative and postoperative pain management in patients undergoing cardiac surgery with sternotomy. However, using lower doses of opioids may achieve the well-established benefits of the fast-track approach, with minimal opioid-related side effects. Postoperative pain is coupled with a long stay in the intensive care unit. Read More

Intern Med 2021 Jan 12;60(1):151-153. Epub 2020 Aug 12.

Department of Emergency Medicine, Hiroshima Citizens Hospital, Japan.

Tetanus is a nervous system disorder characterized by muscular spasms and autonomic hyperactivity, such as unstable blood pressure. We herein report a case of tetanus in a patient in shock complicated with a rectus sheath hematoma caused by rupture of a pseudo-aneurysm of the inferior epigastric artery. A rectus sheath hematoma might be misdiagnosed as unstable blood pressure associated with autonomic hyperactivity, which is usually observed in patients with tetanus. Read More

J Artif Organs 2021 Jun 9;24(2):282-286. Epub 2020 Aug 9.

Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.

Spontaneous abdominal wall hematomas are relatively rare and mainly attributed to anticoagulation and severe cough. Despite the high incidence of anticoagulation-related bleeding complications, there are no reports of spontaneous abdominal wall hematomas during extracorporeal membrane oxygenation (ECMO). We report a case of a spontaneous rectus sheath hematoma caused by alternation of the lateral semi-prone position during ECMO in a 76-year-old female patient with severe acute respiratory distress syndrome. Read More