Rectus sheath hematoma

{{Short description|Accumulation of blood in the sheath of the rectus abdominis muscle}}

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A rectus sheath hematoma is an accumulation of blood in the sheath of the rectus abdominis muscle. It causes abdominal pain with or without a mass.

The hematoma may be caused by either rupture of the epigastric artery or by a muscular tear. Several factors have been identified as predisposing risks for rectus sheath hematoma, including coughing, straining, exercise, hypertension, obesity, previous abdominal surgery, subcutaneous injection, trauma and anticoagulant therapy. With an ageing population and the widespread use of anticoagulant medications, there is evidence that this historically benign condition is becoming more common and more serious.{{Cite journal |last1=Fitzgerald |first1=J. E. F. |last2=Fitzgerald |first2=L. A. |last3=Anderson |first3=F. E. |last4=Acheson |first4=A. G. |year=2009 |title=The changing nature of rectus sheath haematoma: Case series and literature review |journal=International Journal of Surgery |volume=7 |issue=2 |pages=150–154 |doi=10.1016/j.ijsu.2009.01.007 |pmid=19261556 |doi-access=free}} Anticoagulant therapy is used to treat many diseases. However, in the COVID-19 pandemic, anticoagulant therapy was frequently used and therefore the incidence of rectus sheath hematoma increased.{{Cite journal |last1=Mahmoudabadi |first1=Hossein Zabihi |last2=Hadadi |first2=Azar |last3=Fattahi |first3=Mohammad Reza |last4=Kafan |first4=Samira |last5=Ashouri |first5=Mohammad |last6=Allahbeigi |first6=Rashad |last7=Hajebi |first7=Reza |date=2022-02-12 |editor-last=Fan |editor-first=Zhe |title=Rectus Sheath Hematoma in COVID-19 Patients as a Mortal Complication: A Retrospective Report |journal=International Journal of Clinical Practice |language=en |volume=2022 |pages=1–7 |doi=10.1155/2022/7436827 |issn=1742-1241 |pmc=9159132 |pmid=35685571 |doi-access=free }}{{Cite journal |last1=Emekli |first1=Emre |last2=Yıldırım |first2=Mesut |last3=Türkkanı |first3=Mustafa H |last4=Ödemiş Başpınar |first4=Emel |date=2023-05-12 |title=Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings |journal=Cureus |volume=15 |issue=5 |pages=e38943 |language=en |doi=10.7759/cureus.38943 |doi-access=free |issn=2168-8184 |pmc=10259751 |pmid=37313085}} Given that thrombotic events have been documented in numerous studies, it is advisable to initiate prophylactic and anticoagulant treatment during the early phase of COVID-19 disease. {{Cite journal |last1=Miesbach |first1=Wolfgang |last2=Makris |first2=Michael |date=2020-01-01 |title=COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation |journal=Clinical and Applied Thrombosis/Hemostasis |language=en |volume=26 |pages=107602962093814 |doi=10.1177/1076029620938149 |issn=1076-0296 |pmc=7370334 |pmid=32677459}}

On abdominal examination, people may have a positive Carnett's sign.

Most hematomas resolve without treatment, but they may take several months to resolve.

File:CT of rectus sheath hematomas.png|Multiplanar CT scan of a spontaneous rectus sheath hematoma because of warfarin treatment.

File:Rektusscheidenhaematom - CT axial - mit aktiver Blutung.jpg|Rectus sheath hematoma seen on axial CT – with active bleeding under Marcoumar

File:UOTW 13 - Ultrasound of the Week 1.webm|Rectus sheath hematoma as seen on ultrasound{{cite web|title=UOTW #13 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-13/|website=Ultrasound of the Week|access-date=27 May 2017|date=12 August 2014}}