Rectus sheath hematoma (RSH) (see the image below) is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric arteries or their branches or from a direct tear of the rectus muscle.
How is rectus sheath hematoma treated?
Conservative treatment of rectus sheath hematoma includes rest; analgesics; hematoma compression; ice packs; treatment of predisposing conditions; and if necessary, more aggressive therapies of intravenous fluid resuscitation, reversal of anticoagulation, and transfusion.
Is rectus sheath hematoma serious?
Summary. 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.
How painful is a rectus sheath hematoma?
Symptoms of hypovolemic shock with weakness, confusion, pallor, and diaphoresis can develop in patients with a large rectus sheath hematoma. The most common presenting symptom is acute abdominal pain. The onset of pain may be sudden, but more often, it develops over a period of several hours.
How long does it take for a rectus sheath hematoma to heal?
The majority of patients recover well with no complications as the hematoma is reabsorbed in 2 to 3 months.  In those with an indication for therapeutic anticoagulation, patients should be counseled on the risk for recurrence with the resumption of therapy.
What does a rectus sheath hematoma look like?
Patients usually present with unilateral, small, spindle-shaped masses because these hematomas are isolated by the rectus sheath and the tendinous inscriptions, causing tamponade of the bleeding. Hematomas below the arcuate line are caused by damage to the inferior epigastric artery or its perforating branches.
How do you get a rectus sheath hematoma?
Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma.
What is a rectus sheath hernia?
Rectus sheath hernias (alternative plural: herniae) are a very seldom seen form of herniation through the anterior abdominal wall. Herniation of intra-abdominal contents (mesenteric fat +/- bowel), is usually through the posterior rectus sheath only and thus these are often termed posterior rectus sheath hernias.
What does the rectus sheath do?
The function of the rectus sheath is to protect the muscles and vessels which it encloses. In addition, keeping the rectus abdominis and pyramidalis muscle together helps in providing maximal compression of and support to abdominal viscera.
What causes an abdominal hematoma?
Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They result from rupture of the epigastric vessels or the deep circumflex iliac artery (rarely), or from tears of the fibers of the rectus abdominis or lateral oblique muscles [1,2].
How serious is an abdominal hematoma?
Although rarely life-threatening, they can be severe and lead to hemodynamic instability. However, in most cases, rectus hematoma is self-limiting and usually spontaneously resolves. Like in other types of bleeding, the cause can be due to the bleeding tendency, anticoagulation, or injury to the vessels.
Can an abdominal hematoma be fatal?
While the development of an abdominal wall haematoma is relatively uncommon, when they occur they can have fatal consequences.