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.
What are the symptoms of a rectus sheath hematoma?
The typical presentation of a rectus sheath hematoma is abdominal pain and its associated symptoms like nausea and vomiting. The pain is often sudden in onset, sharp, and does not radiate. In extremely rare cases, the hematoma may be large and present with hypovolemia, tachycardia, and tachypnea.
How long does it take 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.
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.
Is rectus sheath hematoma serious?
Although usually a benign self-limiting condition, rectus sheath hematoma (RSH) may be fatal. Mortality figures are prone to error because of the uncommon incidence of rectus sheath hematoma and the paucity of recent mortality data. Overall, the mortality rate is reported to be 4%.
What causes 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.
How is rectus sheath hematoma diagnosed?
The best diagnostic modality to evaluate a suspected RSH is an abdominal computerized tomography (CT) scan, which is more specific than ultrasonography. (Abdom Imaging 1996;21:62.) Sonographic findings are nonspecific in some cases, and can mimic abdominal wall tumors and inflammatory diseases.
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.
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.
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.
How do you treat a hematoma on your stomach?
Conservative treatment including bed rest and analgesics are appropriate in most patients with abdominal wall hematomas. Although most are self-limiting because the bleeding usually stops without intervention, some patients show significant morbidity and the overall mortality rate is reported to be 4%.
When should you worry about a hematoma?
Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if: The bruise lasts longer than 4 weeks. The bruise gets bigger or becomes more painful. You do not get better as expected.
What helps a hematoma heal faster?
These measures usually help to reduce inflammation and diminish its symptoms.
- Ice (Apply the ice or cold pack for 20 minutes at a time, 4 to 8 times a day.)
- Compress (Compression can be achieved by using elastic bandages.)
- Elevate (Elevation of the injured area above the level of the heart is recommended.)
Does hematoma go away?
Mild hematomas and contusions typically heal within about five days. A large hematoma may last weeks to months and as it heals it will change color and slowly shrink in size. Hematoma pain and swelling may be treated with over-the-counter (OTC) pain medications. Aspirin should not be used as it may increase bleeding.
What are 3 causes of a hematoma?
Some causes of hematomas are pelvic bone fractures, fingernail injuries (subungual), bumps, passing blood clots, blood clots in the leg (DVT), blood cancers, and excessive alcohol use.
Is hematoma a blood clot?
What is a hematoma? A hematoma is the result of a traumatic injury to your skin or the tissues underneath your skin. When blood vessels under your skin are damaged and leak, the blood pools and results in a bruise. A hematoma forms as your blood clots, resulting in swelling and pain.