A Conservative Approach to Rectus Sheath Haematomas
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Dicle University Medical Faculty, Diyarbakır, Turkey
Publication date: 2011-07-11
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Akın Önder   

Dicle Universitesi, Tıp Fakültesi Genel Cerrahi AD. 21280, Diyarbakır, Turkey
Eur J Gen Med 2011;8(3):224-228
Aim: Rectus sheath haematoma (RSH) is the result of a rupture of epigastric vessels or rectus muscle occurring mostly in infraumblical region. Etiological factor is predominantly trauma and rarely spontaneous. Generally, misdiagnosed or delays in diagnosis result in unnecessary surgical intervention. Method: Between December 2008 and September 2009, five patients diagnosed for RSH in our hospital retrospectively analyzed in terms of the demographical characteristics, clinical and radiological findings and length of stay in hospital. Result: The average age of the patients was 67 (59-76) years and all were female. At least one of the patients had a systematic disease. All the patients were using anticoagulant and none of them had trauma story. On physical examination, we determined palpable masses loca ted as follows; in left lower quadrant of three patients, in right lower quadrant of one patient and in left upper quadrant of one patient. The types of RSH in radiological imaging were Type 1 in one patient, Type 2 in three patients and Type 3 in one patient. Anticoagulant treatments were stopped and all patients were treated conservatively. The average stay in hospital time of the patients was 8 days. The computed tomography control at the end of the first month revealed that the mass disappeared in cases with Type 1 RSH while the other four cases had a marked decrease in the mass size. Conclusion: RSH should be taken into consideration in differential diagnosis when elder patients – especially females – with anemia, palpable mass, anticoagulant medication history admitted to clinics with acute abdomen. Early diagnosis of RSH provides the preventing of the unnecessary surgical interventions and determines the success of conservative treatment.
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