Spontaneous rectus sheath hematoma in patients on anticoagulation therapy [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2011; 17(3): 210-214 | DOI: 10.5505/tjtes.2011.84669  

Spontaneous rectus sheath hematoma in patients on anticoagulation therapy

Ahmet Dağ1, Turkay Özcan2, Özgür Türkmenoğlu1, Tahsin Çolak1, Kerem Karaca3, Hakan Canbaz1, Musa Dirlik1, Ramazan Saribay1
1Medical Faculty Of Mersin University, Department Of General Surgery, Mersin
2Medical Faculty Of Mersin University, Department Of Cardiology, Mersin
3Medical Faculty Of Mersin University, Department Of Cardiovascular Surgery, Mersin

BACKGROUND
This clinical study was conducted to present the clinical features, treatment and outcomes of rectus sheath hematoma (RSH), which is a complication of anticoagulation therapy that can present as acute abdomen.
METHODS
Twenty-two spontaneous RSH cases who were on anticoagulation therapy were reviewed. Patient characteristics, anticoagulant therapy form and indications, clinical presentation, radiologic work-up, treatment modalities, recurrence, morbidity, and follow-up data were analyzed.
RESULTS
The majority of the patients were female (64%), and the mean age was 60.6 years. All of the patients (100%) were receiving at least one form of anticoagulation therapy; most (72%) were on warfarin therapy. History of coughing was found in 45% of the cases. The most common presenting signs and symptoms were abdominal pain and mass (77%). International normalized ratio (INR) was >3.0 in all patients on warfarin therapy. The diagnosis was made by abdominopelvic ultrasonography (US) and computerized tomography (CT). CT showed 100% sensitivity. The majority of patients (87%) were treated conservatively. Three patients (13%) were operated and 2 patients (9%) died as a result of RSH. Two patients experienced recurrence in one year.
CONCLUSION
RSH should be suspected in elderly, coughing patients on anticoagulation therapy, who present with clinical manifestations of acute abdomen. Early diagnosis can help to avoid increased morbidity or unnecessary surgical intervention.

Keywords: Acute abdomen, anticoagulation; rectus sheath hematoma.


Antikoagülan tedavi altındaki hastalarda spontan rektus kılıfı hematomu

Ahmet Dağ1, Turkay Özcan2, Özgür Türkmenoğlu1, Tahsin Çolak1, Kerem Karaca3, Hakan Canbaz1, Musa Dirlik1, Ramazan Saribay1
1Mersin Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Mersin
2Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin
3Mersin Üniversitesi Tıp Fakültesi, Kalp-damar Cerrahisi Anabilim Dalı, Mersin

AMAÇ
Antikoagülan tedavinin bir komplikasyonu olan ve akut karın kliniği oluşturan rektus kılıfı hematomunun (RKH) klinik özelliklerini, tedavisini ve sonuçlarını sunmayı amaçladık.
GEREÇ VE YÖNTEM
Antikoagülan tedaviye bağlı gelişen 22 RKH olgusu incelendi. Olguların klinik özellikleri, antikoagülan tedavinin şekli ve endikasyonları, radyolojik bulgular, tedavi yöntemleri, nüksetme, morbidite ve mortalite bilgileri incelendi.
BULGULAR
Olguların %72’si kadın olup, yaş ortalaması 60.6 idi. Tüm olgular (%100) antikoagülan tedavisinin en az bir türünü, %72’si varfarin tedavisi almaktaydı. Olguların %45’inde öksürük hikayesi bulunmuştu. En sık karşılaşılan bulgu ve semptomlar karın ağrısı ve kitleydi (%77). Varfarin tedavisi gören olgularda INR (International Normalized Ratio) ortalaması 3’ün üstünde bulunmuştu. Tanılar, abdominopelvik ultrasonografi ve bilgisayarlı tomografi (BT) aracılığıyla konuldu, BT %100 duyarlılık gösterdi. Olguların çoğu (%87) konservatif tedavi aldı. Üç olgu (%13) ameliyat edildi. İki olgu (%9) RKH sonucu hayatını kaybetti, 2 olgu da bir yıl içinde hastalık tekrarladı.
SONUÇ
Akut karın kliniğiyle gelen, yaşlı, öksüren ve antikoagülan tedavi alan hastalarda RKH den şüphelenilmelidir. Tercih edilen tanı şekli BT’dir. Erken tanı, morbiditeyi ve gereksiz cerrahi müdahaleyi önler.

Anahtar Kelimeler: Akut karın, antikoagulasyon; rektus kılıfı hematomu.


Ahmet Dağ, Turkay Özcan, Özgür Türkmenoğlu, Tahsin Çolak, Kerem Karaca, Hakan Canbaz, Musa Dirlik, Ramazan Saribay. Spontaneous rectus sheath hematoma in patients on anticoagulation therapy. Ulus Travma Acil Cerrahi Derg. 2011; 17(3): 210-214

Corresponding Author: Ahmet Dağ, Türkiye


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