Spontaneous rectus sheath hematoma in patients on anticoagulation therapy

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.

Antikoagülan tedavi altýndaki hastalarda spontan rektus kýlýfý hematomu

AMAÇ
Antikoagülan tedavinin bir komplikasyonu olan ve akut karýn kliniði oluþturan rektus kýlýfý hematomunun (RKH) klinik özelliklerini, tedavisini ve sonuçlarýný sunmayý amaçladýk.
GEREÇ VE YÖNTEM
Antikoagülan tedaviye baðlý geliþen 22 RKH olgusu incelendi. Olgularýn klinik özellikleri, antikoagülan tedavinin þekli ve endikasyonlarý, radyolojik bulgular, tedavi yöntemleri, nüksetme, morbidite ve mortalite bilgileri incelendi.
BULGULAR
Olgularýn %72’si kadýn olup, yaþ ortalamasý 60.6 idi. Tüm olgular (%100) antikoagülan tedavisinin en az bir türünü, %72’si varfarin tedavisi almaktaydý. Olgularýn %45’inde öksürük hikayesi bulunmuþtu. En sýk karþýlaþýlan bulgu ve semptomlar karýn aðrýsý ve kitleydi (%77). Varfarin tedavisi gören olgularda INR (International Normalized Ratio) ortalamasý 3’ün üstünde bulunmuþtu. Tanýlar, abdominopelvik ultrasonografi ve bilgisayarlý tomografi (BT) aracýlýðýyla konuldu, BT %100 duyarlýlýk gösterdi. Olgularýn çoðu (%87) konservatif tedavi aldý. Üç olgu (%13) ameliyat edildi. Ýki olgu (%9) RKH sonucu hayatýný kaybetti, 2 olgu da bir yýl içinde hastalýk tekrarladý.
SONUÇ
Akut karýn kliniðiyle gelen, yaþlý, öksüren ve antikoagülan tedavi alan hastalarda RKH den þüphelenilmelidir. Tercih edilen taný þekli BT’dir. Erken taný, morbiditeyi ve gereksiz cerrahi müdahaleyi önler.