A Rare Cause of Acute Abdominal Pain due to Anticoagulant Use: Spontaneous Rectus Sheath Hematoma

Year 2023, Volume: 1 Issue: 3, 105 - 107, 31.10.2023

Vefa Atış , Rıfat Peksöz , Sultan Tuna Akgol Gur

Abstract

Although rectus sheath hematoma may be the result of bleeding into the rectus abdominis muscle or direct muscle rupture, non-traumatic spontaneous rectus muscle hematoma is a rare clinical presentation. In this case report, a case of spontaneous rectus muscle hematoma occurring in a patient who was initiated warfarin sodium for anticoagulation purposes after heart valve replacement surgery was presented. A 41-year-old female patient was admitted to our hospital with complaints of abdominal pain that started as a result of cough that had been going on for 2 days. The patient was receiving warfarin sodium treatment for anticoagulation purposes after heart valve replacement. On physical examination, there were ecchymosis, swelling and stiffness in the left lower quadrant of the abdomen. There was also defense in the bulging part. There was no history of abdominal trauma in the patient’s history. Rectus sheath hematoma was detected in abdominal ultrasonography and computed tomography scan. The patient was admitted to the general surgery service with the diagnosis of spontaneous rectus muscle hematoma. Warfarin sodium was antagonized using intravenous vitamin K. On the 10th day of admission, the patient’s hemoglobin level was stable and his vital signs were stable and she was discharged without any complications. It should be kept in mind that spontaneous rectus sheath hematoma may occur in patients who present to the hospital with abdominal pain, have no history of trauma, and use warfarin sodium.

Keywords

Abdominal rectus muscle, Hematomas, Abdominal pain, Warfarin sodium

Antikoagülan Kullanımına Bağlı Akut Karın Ağrısının Nadir Bir Nedeni: Spontan Rektus Kılıf Hematomu

Abstract

Rektus kılıf hematomu, rektus abdominis kasına kanama veya direkt kas yırtılması sonucu olabilmekle beraber, travmatik olmayan spontan rektus kas hematomu nadir görülen bir klinik tablodur. Bu olgu sunumunda, kalp kapak replasmanı cerrahisi sonrası antikoagülasyon amaçlı varfarin sodyum başlanan bir hastada meydana gelen spontan rektus kas hematomu olgusu sunulmaktadır. 41 yaşında kadın hasta 2 gündür devam eden öksürük sonucu başlayan karın ağrısı şikayetleri ile hastanemize başvurdu. Hasta kalp kapak replasmanı sonrası antikoagülasyon amaçlı varfarin sodyum tedavisi almaktaydı. Hastanın fizik muayenesinde batın sol alt kadranda ekimoz, şişkinlik ve sertlik mevcuttu. Ayrıca şişkin kısımda defans vardı. Hastanın öyküsünde herhangi bir karın travması öyküsü yoktu. Abdominal ultrasonografide ve bilgisayarlı tomografide taramasında rektus kılıf hematomu tespit edildi. Hasta spontan rektus kas hematomu tanısı ile genel cerrahi servisine yatırıldı. Varfarin sodyum, intravenöz K vitamini kullanılarak antagonize edildi. Başvurusunun 10. gününde hemoglobin değeri stabil olan, vital bulguları stabil olan hasta komplikasyonsuz bir şekilde taburcu edildi. Hastaneye karın ağrısı ile başvuran, travma öyküsü olmayan ve varfarin sodyum kullanan hastalarda spontan rektus kılıf hematomu olabileceği akılda bulundurulmalıdır.

Keywords

Abdominal rektus kası, Hematomlar, Karın ağrısı, Varfarin sodyum.

Supporting Institution

Destekleyen kurum yoktur

References

• Kalayci T. Rectus sheath hematoma due to low molecular weight heparin in a COVID-19 patient in Turkey. Cureus. 2021;13(5): e14870.
• Siu WT, Tang CN, Law BK, Chau CH, Li MK. Spontaneous rectus sheath hematoma. Can J Surg. 2003;46(5):390.
• Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution. Medicine. 2006;85(2):105-10.
• Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. Int J Surg. 2015;13:267-71.
• Salemis NS, Gourgiotis S, Karalis G. Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study. Int J Surg. 2010;8(4):290-3.
• Kalayci T. Diagnosis and treatment of medically treated rectus sheath hematoma caused by stabbing. Arch Trauma Res. 2022;11(4):218-21.
• Kalayci T, Kartal M. Conservative treatment of rectus sheath hematoma after diagnostic laparoscopy. Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi. 2022;2(3):639-46.
• Wegener ME, Ghani A. Rectus sheath hematomas in hematological disorders. Am Surg. 1994;60(6):424-6.
• Tolcher MC, Nitsche JF, Arendt KW, Rose CH. Spontaneous rectus sheath hematoma pregnancy: case report and review of the literature. Obstet Gynecol Surv. 2010;65(8):517-22.
• Kalaycı T, Kartal M, Yeni M. How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up? Ulus Travma Acil Cerrahi Derg. 2022;28(10):1468-74.
• Allen M, Sevensma KE. Rectus sheath hematoma. StatPearls [Internet]: StatPearls Publishing; 2022.
• Povar M, Lasala M, Ruiz A, Povar B, editors. Rectus sheath haematoma: experience in our centre. Anales del sistema sanitario de Navarra; 2017.
• Shikhman A, Tuma F. Abdominal hematoma. 2018.
• İliklerden ÜH, Kalaycı T. Treatment of rectus sheath hematomas: Eight years of single-center experience with a review of literature. Ulus Travma Acil Cerrahi Derg 2021;27(2):222-30.
• Yale SH, Tekiner H, Yale ES. Fothergill and Carnett signs and rectus sheath hematoma. J Rural Med. 2020;15(3):130-1.
• Osinbowale O, Bartholomew JR. Rectus sheath hematoma. Vasc Med. 2008;13(4):275-9.
• Jafferbhoy SF, Rustum Q, Shiwani MH. Abdominal compartment syndrome–a fatal complication from a rectus sheath haematoma. Case Rep. 2012;2012:bcr1220115332.
• Dohan A, Sapoval M, Chousterman BG, Di Primio M, Guerot E, Pellerin O. Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. Am J Roentgenol. 2015;204(6):1303-10.