Rectus sheath haematoma: experience in our center

Authors

  • M. Povar Hospital Universitario Miguel Servet
  • M. Lasala Hospital Universitario Miguel Servet
  • A. Ruiz Hospital Universitario Miguel Servet
  • B. J. Povar Hospital Universitario Miguel Servet

DOI:

https://doi.org/10.23938/ASSN.0044

Keywords:

Spontaneous rectus sheath hematoma. Abdominal wall disease. Anticoagulant therapy. Transcatheter embolization. Abdominal pain.

Abstract

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 treatmentwere analyzed.

Results. The median age of patients was 81 years, 61% were female. The most frequent triggers were persistent coughing and injection of low molecular weight heparin. Seventy percent were anticoagulated, of which 57% had INR in the supratherapeutic range, and in 45% anticoagulation was definitively discontinued after admission. Forty-one percent presented chronic renal failure; moreover, creatinine at the time of diagnosis was higher than baseline (p <0.001). In most cases, treatment was conservative; interventional radiology was performed on three patients (6.5%) and open surgery on four (8.7%). Invasive treatment was employed with patients who had larger hematomas and higher transfusion requirements, and this was associated with a longer mean stay (p<0.001).

Conclusions. RSH is more frequent in elderly patients, treated with acenocumarol and in the supratherapeutic range, and frequently entails permanent suspension of anticoagulant therapy. Renal insufficiency is related to the overdosage of the anticoagulant treatment and to the production of the hematoma. The size of RSH and transfusion requirements are factors that seem to be related to a greater need for invasive treatment through arterial embolization or surgery.

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Author Biography

M. Povar , Hospital Universitario Miguel Servet

Medicina Interna

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Published

2017-12-29

How to Cite

Povar, M., Lasala, M., Ruiz, A., & Povar, B. J. (2017). Rectus sheath haematoma: experience in our center. Anales Del Sistema Sanitario De Navarra, 40(3), 361–369. https://doi.org/10.23938/ASSN.0044

Issue

Section

Research articles