Is rectus sheath hematoma fatal?
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%.
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. [6] In those with an indication for therapeutic anticoagulation, patients should be counseled on the risk for recurrence with the resumption of therapy.
Is a rectus sheath hematoma painful?
4. Conclusion. Although uncommon, rectus sheath hematoma is a significant cause of abdominal pain that can imitate surgical acute abdomen. Physicians should consider this diagnosis in patients with the above described predisposing factors.
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 is found in the rectus sheath?
The rectus sheath is the durable, resilient, fibrous compartment that contains both the rectus abdominis muscle and the pyramidalis muscle. The fascial coverings of the external oblique, internal oblique, and transversus abdominis muscles comprise the rectus sheath.
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.
What is a rectus sheath catheter?
Introduction. Rectus sheath catheters (RSCs) are increasingly being used to provide postoperative analgesia following laparotomy for colorectal surgery. Little is known about their efficacy in comparison with epidural infusion analgesia (EIA).
What are the symptoms of a rectus sheath hematoma?
Specific symptoms Fever and chills are common symptoms in 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.
What causes a hematoma of rectus sheath?
The hematoma may be caused by either rupture of the epigastric artery or by a muscular tear. Causes of this include anticoagulation, coughing, pregnancy, abdominal surgery and trauma.
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.
What is a hematoma of rectus sheath?
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.
What is a rectus sheath hematoma?
When does rectus sheath hematoma occur during pregnancy?
Rectus sheath hematoma is associated with pregnancy in the gravid state, during labor, and in the early postpartum period. Abdominal operations predispose to rectus sheath hematoma because surgical scars redirect the shearing forces on muscle contraction, placing more stress on the epigastric vessels.
What causes abdominal pain with rectus sheath hematoma?
Background. 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.
Can a rectus sheath hematoma recur after resolution?
After resolution, rectus sheath hematomas usually do not recur and typically do not cause long-term sequelae. Several risk factors of rectus sheath hematoma (RSH) can be obtained in the history. In most cases of rectus sheath hematoma, one or more precipitating factors can be found.
What is the predisposing factor for rectus sheath hematoma?
Reports of spontaneous rectus sheath hematoma exist, but more likely, in these cases, the precipitating factor was not appreciated. Anticoagulation is the most frequent predisposing factor, and severe coughing is the most important inciting factor. Rectus sheath hematoma is a well-recognized complication of anticoagulant therapy.