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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 Mar 14. 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 2018 Sep 18. Epub 2018 Sep 18.

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

Clin Pract 2017 Jun 1;7(3):957. Epub 2017 Aug 1.

Division of Hospital Medicine, Henry Ford Hospital, Detroit, MI, USA.

Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Read More

Case Rep Radiol 2017 13;2017:3420313. Epub 2017 Jul 13.

ASST Santi Paolo and Carlo, San Carlo Borromeo Hospital, Department of Diagnostic Science, Radiology and Interventional Radiology Unit, Via Pio II 3, 20153 Milano, Italy.

We treated a 78-year-old female affected by nontraumatic spontaneous rectus sheath hematoma. We decided to perform the embolization with the new liquid agent Squidperi. Complete exclusion of the bleeding vessel was obtained without complications. Read More

Abdom Radiol (NY) 2018 03;43(3):723-733

Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079, Dijon Cedex, France.

Purpose: To assess the efficacy and the safety of Glubran2 n-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) transcatheter arterial embolization (TAE) for acute arterial bleeding from varied anatomic sites and to evaluate the predictive factors associated with clinical success and 30-day mortality.

Methods: A retrospective review of consecutive patients who underwent emergent NBCA-MS Glubran2 TAE between July 2014 and August 2016 was conducted. Variables including age, sex, underlying malignancy, cardiovascular comorbidities, coagulation data, systolic blood pressure, and number of red blood cells units (RBC) transfused before TAE were collected. Read More

Pan Afr Med J 2017 8;27:19. Epub 2017 May 8.

Bitlis State Hospital, Department of Emergency Medicine, 13000 Bitlis/Turkey.

Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and confirmed as RSH by computed tomography. Read More

Asian J Endosc Surg 2017 Aug;10(3):336-338

Department of Gastroenterological and General Surgery, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan.

Introduction: A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. Read More

Radiographics 2017 Jul-Aug;37(4):1218-1235

From the Departments of Radiology (S.A.M., A.D.S., B.K.) and Trauma, Burns, and Critical Care (R.A., J.D.G.), Brigham and Women's Hospital, 75 Francis St, Mellins Library, Boston, MA 02115; and Shields Radiology, Brockton, Mass (K.P.).

Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury). Read More

Lancet Gastroenterol Hepatol 2017 07;2(7):538

Internal Medicine Department, Hospital of Laredo, Cantabria, Spain.

J Clin Diagn Res 2017 Mar 1;11(3):PD11-PD12. Epub 2017 Mar 1.

Assistant Professor, Department of General Surgery, BVVS S Nijalingappa Medical College and HSK Hospital and Research Centre, Navanagar, Bagalkot, Karnataka, India.

Rectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Read More

Med Ultrason 2017 Apr;19(2):239-240

Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, United States.

. Read More

BMJ Case Rep 2017 Apr 13;2017. Epub 2017 Apr 13.

Internal Medicine, Mercy St. Vincent's Medical Center, Toledo, Ohio, USA.

Rectus sheath haematoma is a rare cause of abdominal pain. It can be easily confused for other causes of acute abdomen and may even lead to unnecessary laparotomies. Our patient has the rectus sheath haematoma because of violent coughing and on presentation had no obvious clinical sign pointing to the same. Read More

J Clin Neurosci 2017 07 9;41:72-74. Epub 2017 Apr 9.

Baskent University, Department of Neurosurgery, Alanya Teaching and Medical Research Center, Alanya, Turkey.

Ren Fail 2017 Nov;39(1):414-416

b Department of Nephrology , Affiliated Hospital of Jining Medical College , Jining , Shandong , China.

Rectus sheath hematomas (RSHs) are uncommon. They are usually unilateral and rarely bilateral. In this paper, we report the first case of spontaneous bilateral RSHs in a uremic patient after the administration of the first dose of low-molecular weight heparin during hemodialysis. Read More

S Afr J Surg 2016 Jun;54(2):55-56

Department of General Surgery, Sefako Makgatho Health Sciences University; Dr George Mukhari Academic Hospital.

Rectus sheath haematoma (RSH) is an uncommon cause of acute abdominal pain, but can mimic a variety of acute surgical conditions. Computed tomography (CT) provides the diagnosis and avoids unnecessary procedures. Read More

J Vasc Surg Venous Lymphat Disord 2017 03 12;5(2):165-170. Epub 2017 Jan 12.

The Cardiovascular Care Group, Westfield, NJ. Electronic address:

Objective: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for acute pulmonary embolism (PE) in patients deemed to be "high risk" for thrombolytic therapy.

Methods: A retrospective evaluation of patients who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 patients considered, all of whom presented with acute PE as diagnosed by computed tomography angiography. Read More

BMC Res Notes 2017 Jan 7;10(1):26. Epub 2017 Jan 7.

Internal Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka.

Background: The management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken. Read More