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J Ultrasound 2020 Jul 3. Epub 2020 Jul 3.

Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.

Spontaneous rectus sheath hematoma (SRSH) is an uncommon cause of acute abdominal pain characterized by bleeding within the rectus sheath; it is a benign condition and, in most cases, it is treated conservatively. Bleeding of the abdominal wall is an unusual condition that is quite challenging to identify promptly and can be easily overlooked during a routine physical examination. In daily practice, anticoagulant therapy is one of the main risk factors for hemorrhagic events. Read More

Cureus 2020 May 5;12(5):e7974. Epub 2020 May 5.

General Surgery, Boca Raton Regional Hospital, Boca Raton, USA.

A 93-year-old woman on Coumadin with history of atrial fibrillation and chronic obstructive pulmonary disease (COPD) presented with urinary retention for one day. Computed tomography (CT) of abdomen and pelvis demonstrated grade 3 rectus sheath hematoma (RSH), with the hematoma dissecting between the transversalis fascia and muscle into the prevesical space. The large-sized hematoma caused compression at the bladder outflow tract causing urinary retention. Read More

Cureus 2020 May 2;12(5):e7938. Epub 2020 May 2.

Nephrology, General Hospital of Livadeia, Livadeia, GRC.

Rectus sheath hematoma (RSH), an exceptionally rare clinical entity, results from the rupture of epigastric arteries or tear of the rectus abdominis muscle itself. Spontaneous RSH represents a potentially life-threatening bleeding complication in anticoagulated patients with distinct characteristics. The non-specific nature of RSH clinical manifestations renders RSH a kaleidoscopic disease that may be misdiagnosed. Read More

Ulus Travma Acil Cerrahi Derg 2020 Mar;26(2):320-324

Department of Radiology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Resarch Hospital, İstanbul-Turkey.

Background: In this study, we aimed to review spontaneous rectus sheath hematoma (RSH) and the results of endovascular therapy in patients presenting with a rare acute abdomen.

Methods: We evaluated the patients with RSH because of acute abdominal pain and applied endovascular embolization treatment who were admitted to our hospital emergency department retrospectively between December 2016 and December 2018.

Results: Rectus muscle sheath bleeding is an extremely rare and urgent emergency intervention. Read More

Breast J 2020 Feb 16. Epub 2020 Feb 16.

Portsmouth Hospitals Trust, Portsmouth, UK.

JA Clin Rep 2019 Mar 2;5(1):16. Epub 2019 Mar 2.

Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1 West 13, Chuo-Ku, Sapporo, Hokkaido, 090-8666, Japan.

Background: Severe abdominal pain caused by a rectus sheath hematoma (RSH) can decrease a patient's activities of daily living. A case of postoperative RSH for which a continuous rectus sheath block (RSB) was effective is reported.

Case Presentation: A 62-year-old woman who had no previous medical history underwent hysterectomy, total cystectomy, and ileal conduit surgery for bladder cancer under epidural and general anesthesia. Read More

AACE Clin Case Rep 2019 Sep-Oct;5(5):e267-e270. Epub 2019 Jun 7.

Objective: We report an unusual case of untreated hypoparathyroidism in which the patient presented with a prolonged QT interval and unusual bleeding after the institution of acute coronary syndrome (ACS) protocol.

Methods: A 53-year-old female presented with sudden pain and diffuse tightness in the abdomen/limbs and profuse sweating for a few hours. Patient was admitted under cardiology services and ACS protocol was instituted. Read More

Ulus Travma Acil Cerrahi Derg 2020 Jan;26(1):50-54

Department of General Surgery, Recep Tayyip Erdoğan University Training and Research Hospital, Rize-Turkey.

Background: The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tend to limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Read More

J Rural Med 2019 Nov 20;14(2):245-248. Epub 2019 Nov 20.

Department of Gastroenterology, Mito Saiseikai General Hospital, Japan.

Rectus sheath hematoma (RSH) can result from bleeding into the rectus abdominis muscle or a direct muscular tear; nontraumatic spontaneous RSH is a rare condition. Here, we report a case of spontaneous RSH associated with warfarin administration for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). An 87-year-old woman was referred to our hospital because of abdominal pain, nausea, and vomiting for 3 days. Read More

J Vasc Interv Radiol 2020 Feb 14;31(2):323-330. Epub 2019 Nov 14.

Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908.

Purpose: To evaluate radiographic, laboratory, and clinical factors associated with conservative management (CM) failure in spontaneous rectus sheath hematoma (RSH).

Materials And Methods: Retrospective review of 72 patients with spontaneous RSH between 2006 and 2017 was performed. Patients were initially managed conservatively and then divided into 2 groups based on decision to embolize. Read More

Afr Health Sci 2019 Jun;19(2):2290-2293

Department of Internal Medicine, Bozok University, School of Medicine, Yozgat, Turkey.

Rivaroxaban is one of the new anti-coagulants that inhibit Factor Xa and rarely cause rectus sheath hematoma and retroperitoneal haemorrhage which are uncommon, life-threatening complications. Here is a case of an elderly patient on rivaroxaban therapy for the stroke prevention in non-valvular atrial fibrillation who developed rectus sheath hematoma and retroperitoneal bleeding. Read More

Ultrasound J 2019 Jun 18;11(1):13. Epub 2019 Jun 18.

Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea, 7630, Argentina.

Background: Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality.

Case Presentation: An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Read More

Am J Surg 2020 04 12;219(4):726-727. Epub 2019 Jun 12.

Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA.

Case Rep Emerg Med 2019 23;2019:3158969. Epub 2019 May 23.

Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan.

Rectus sheath hematoma is an unusual but well-known clinical problem. Our hospital admitted a 54-year-old woman complaining of harsh right-sided hypogastric pain that started while muscle training. Computed tomography of the abdomen and pelvis demonstrated a right rectus sheath hematoma. Read More

Am J Surg 2020 04 14;219(4):707-710. Epub 2019 May 14.

Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.

Background: Retroperitoneal and rectus sheath hematomas can occur spontaneously. There is a lack of research about the disease progression, optimal treatment strategies and the need for surgical intervention. Our study investigated their outcomes and management. Read More

Emerg Med Int 2019 21;2019:2406873. Epub 2019 Feb 21.

Department of Radiology, Kanuni Training and Research Hospital, Trabzon, Turkey.

Introduction: Spontaneous rectus sheath hematoma (SRSH) is characterized by bleeding within the rectus abdominis muscle sheath, one of the rare causes of acute abdominal pain. Early diagnosis is imperative in SRSH to prevent complications and the treatment is usually conservative. We intended to present in this study our experience with SRSH patients with respect to diagnostic evaluation and management of their disease. Read More

J Emerg Med 2019 Jun 14;56(6):680-683. Epub 2019 Mar 14.

Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland.

Background: Rectus sheath hematoma is a rare but dangerous cause of undifferentiated hypotension and abdominal pain in the emergency department (ED). Point-of-care ultrasound is a useful tool in its identification.

Case Report: A 75-year-old woman presented to the ED with hypotension of an unclear etiology. Read More

Recenti Prog Med 2019 Feb;110(2):89-92

UOC Cardiologia Riabilitativa CTO, ASST Gaetano Pini/CTO, Milano.

Spontaneous rectus sheath hematoma (RSH) is an uncommon and often clinically misdiagnosed cause of abdominal pain, characterized by a presence of blood within rectus muscle sheath, with palpable mass. Hemorrhage may originate from the epigastric artery and branches or directly from rectus sheath rupture. The most frequent cause of hematoma is anticoagulant therapy. Read More

Am J Case Rep 2019 Feb 7;20:163-166. Epub 2019 Feb 7.

Department of Internal Medicine, United Health Services Hospitals, Wilson Medical Center, Johnson City, NY, USA.

BACKGROUND A clinical condition that is often misdiagnosed, rectus sheath hematoma (RSH) is usually seen in the context of blunt abdominal trauma and/or anticoagulation therapy, rarely occurring spontaneously. We present a case of spontaneous rectus sheath hematoma (SRSH) without obvious risk factors and review the literature regarding diagnosis modalities and management. The aim of this case presentation is to highlight this rare clinical condition and emphasize the role of the physical exam in determining the appropriate treatment approach. Read More

Pan Afr Med J 2018;30:88. Epub 2018 May 30.

Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Medicina (Kaunas) 2018 May 30;54(3). Epub 2018 May 30.

Department of Surgery, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.

: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Read More

Ophthalmic Plast Reconstr Surg 2019 May/Jun;35(3):256-261

Orbital, Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Purpose: The authors present the largest series of patients to date of spontaneous hemorrhage in relation to extraocular muscles (EOMs).

Methods: Observational retrospective case series. Institutional review board approval was obtained. Read More

Chirurgia (Bucur) 2018 Jul-Aug;113(4):558-563

Open abdomen is sometimes necessary to save lives after ruptured abdominal aortic aneurysm repair. We report a case in which a staged strategy for early abdominal wall closure was applied to prevent the severe complications due to the extended period of open abdomen. An 81-year-old man with ruptured abdominal aortic aneurysm was transported to our hospital. Read More

Intern Emerg Med 2019 Jan 31;14(1):181-182. Epub 2018 Aug 31.

Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Intern Emerg Med 2018 12 29;13(8):1341-1343. Epub 2018 Aug 29.

Internal Medicine, Resident, Department of Medicine, St. Vincent Hospital, Worcester, MA, USA.

Visc Med 2018 Jul 31;34(3):225-227. Epub 2018 Jan 31.

Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.

Background: Rectus sheath hematoma (RSH) is a rare but potentially dangerous clinical entity that requires medical supervision.

Case Report: Here we discuss one such case which describes the fatal course of spontaneous RSH during hospital admission.

Conclusion: Usually, RSH presents as a minimal abdominal wall swelling with self-limiting course but in the case of hematoma and size progression, specific conservative or invasive measures are necessary to prevent serious complications including hypovolemic shock and death. Read More

J Stroke Cerebrovasc Dis 2018 Dec 16;27(12):e237-e238. Epub 2018 Aug 16.

Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan.

A 76-year-old Japanese man was admitted to our department because of aphasia and right hemiparesis. Brain magnetic resonance imaging showed cerebral infarction caused by occlusion of the left middle cerebral artery, and alteplase therapy was started. Thrombectomy was subsequently performed, resulting in recanalization. Read More

Cureus 2018 Jun 8;10(6):e2769. Epub 2018 Jun 8.

Internal Medicine, Monmouth Medical Center, Long Branch, USA.

Rectus sheath hematoma (RSH) is a rare complication that usually occurs in patients receiving anticoagulation therapy. It can mimic an acute abdomen and be life-threatening. RSH can develop even with prophylactic dose of heparin. Read More

Intern Emerg Med 2018 Dec 2;13(8):1335-1336. Epub 2018 Aug 2.

Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya, Israel.

Emerg (Tehran) 2018 1;6(1):e28. Epub 2018 May 1.

Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Rectus sheath hematoma is a rare but well-known problem. Exercise, pregnancy, subcutaneous injection of insulin, abdominal surgery and severe coughs can be predisposing factors of hemorrhage in the mentioned muscle sheath. Here, we will discuss a case of rectus sheath hematoma in a 28 year-old female patient who presented to emergency department with complaint of abdominal pain and improved in 1 week with palliative care. Read More

BMJ Case Rep 2018 Jul 10;2018. Epub 2018 Jul 10.

Department of Critical Care Medicine, Fortis-Escorts Hospital, Faridabad, Haryana, India.

Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function. Read More

BMJ Case Rep 2018 Jul 10;2018. Epub 2018 Jul 10.

Dept of Urology, Footscray Hospital, Footscray, Victoria, Australia.

Rectus sheath haematoma is an uncommon condition. However, its incidence is increasing, attributed to greater use of anticoagulant therapy. We present the case of an 83-year-old woman on therapeutic enoxaparin for a prior pulmonary embolus who underwent elective right hemicolectomy and developed a rectus sheath haematoma 13 days postoperatively. Read More

Radiol Case Rep 2018 Apr 3;13(2):328-332. Epub 2018 Feb 3.

Radiology Department, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy.

We described the utility of computed tomography (CT) angiography in detection of bleeding vessels for a rapid percutaneous arterial embolization of the spontaneous rectus sheath hematoma. A 70-year-old woman comes to our attention with acute abdominal pain and a low hemoglobin level. An unenhanced CT was performed demonstrating a large rectus sheath hematoma. Read More

BMJ Case Rep 2018 Apr 11;2018. Epub 2018 Apr 11.

Hospital Medicine, Henry Ford Health System, Detroit, Michigan, USA.

Am J Emerg Med 2018 Jul 27;36(7):1257-1261. Epub 2018 Mar 27.

Service des urgences Adultes, CHU Clermont-Ferrand, Clermont-Ferrand (63), France; Université Clermont Auvergne, F-63000 Clermont-Ferrand, France. Electronic address:

Background: According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding.

Objectives: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not.

Materials And Methods: We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. Read More

Saudi Med J 2018 Mar;39(3):301-304

College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Rectus sheath hematoma is a collection of blood in the sheath of rectus abdominis muscle due to an injury of one of the epigastric vessels or the muscle itself. It is a rare condition that could be caused by the use of anticoagulant injections. We report a 60-year-old lady who received enoxaparin injection on the lower abdomen. Read More

Arch Argent Pediatr 2018 Feb;116(1):e82-e84

Turgut Ozal University, Department of Pediatric Surgery, Ankara, Turkey.

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Read More

Am J Ther 2018 Nov/Dec;25(6):e704-e705

Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN.

J Laparoendosc Adv Surg Tech A 2018 Apr 2;28(4):434-438. Epub 2018 Jan 2.

2 Department of Surgery, Tufts University School of Medicine , Boston, Massachusetts.

Purpose: Published results from mesh placement in the preperitoneal space between the posterior fascia and peritoneum for ventral hernia repair are limited. We describe our initial experience regarding the feasibility of a robotic-assisted transabdominal preperitoneal (rTAPP) ventral hernia repair.

Methods: The study is a retrospective review and descriptive analysis of consecutive and prospectively collected data regarding rTAPP ventral hernia repair conducted by a single surgeon between 2014 and 2016. Read More

J Surg Case Rep 2017 Nov 21;2017(11):rjx226. Epub 2017 Nov 21.

Department of Surgery, Einstein Healthcare Network, Philadelphia, PA, USA.

Rectus sheath hematoma (RSH) is an increasingly common clinical condition in our hospitals due to the increasing use of anticoagulant therapies for various purposes among our patients. Treatment of spontaneous RSH is generally conservative. For continued bleeding, interventional radiologic identification and subsequent embolization is an effective option. Read More

Ulus Travma Acil Cerrahi Derg 2017 Nov;23(6):483-488

Department of Gastroenterological Surgery, Kartal Koşuyolu High Speciality Training and Research Hospital, İstanbul-Turkey.

Background: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.

Methods: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.

Results: Of the 27 patients, 19 (70. Read More

R I Med J (2013) 2017 Nov 1;100(11):39-40. Epub 2017 Nov 1.

Division of Cardiology, Mayo Clinic.

[Full article available at http://rimed.org/rimedicaljournal-2017-11.asp]. Read More

J Vasc Interv Radiol 2018 02 19;29(2):210-217. Epub 2017 Oct 19.

Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France. Electronic address:

Purpose: To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality.

Materials And Methods: A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14. Read More

Am J Ther 2018 Jul/Aug;25(4):e510-e511

Department of Medicine, State University of New York, Upstate Medical University, Syracuse, NY.

An Sist Sanit Navar 2017 Dec 29;40(3):361-369. Epub 2017 Dec 29.

Hospital Universitario Miguel Servet.

Background: To describe the clinical characteristics of patients diagnosed with spontaneous abdominal rectus muscle hematoma (RSH), predisposing and precipitating factors, and therapeutic management.

Method: Retrospective descriptive study of 46 RSH diagnosed from 2002 to 2016. Epidemiological, clinical, diagnostic tests and treatment were analyzed. Read More

Arch Med Sci Atheroscler Dis 2017 13;2(1):e1-e2. Epub 2017 Mar 13.

Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital, Istanbul, Turkey.

EJVES Short Rep 2017 17;34:24-27. Epub 2017 Mar 17.

Division of Interventional Radiology, University of Illinois at Chicago, Chicago, IL, USA.

Introduction: Rectus sheath haematomas associated with anticoagulation are often self limiting. When large, however, they can even extend into the pelvis and cause compression of adjacent organs such as the bladder. A combined endovascular and surgical approach can decrease the operative exposure necessary to treat this occurrence. Read More

IDCases 2017 10;10:35-37. Epub 2017 Aug 10.

Abdi Waluyo Hospital, HOS Cokroaminoto Street number 31-33, Jakarta, Indonesia.

Muscle hematomas are rare complications in dengue hemorrhagic fever (DHF). We report a case of 58-year-old-female admitted with dengue fever who developed spontaneous rectus sheath hematoma complicating DHF. She presented with progressive thrombocytopenia with platelet count reaching 13000/μL at its lowest point. Read More