Spontaneous rectus sheath hematoma in cardiac in patients: a single-center experience

BACKGROUND: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.
METHODS: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.
RESULTS: Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32–84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality.
CONCLUSION: RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.

Kardiyak nedenlerle hastanede yatan hastalarda spontan rektus kýlýf hematomu: Tek merkez deneyimi

AMAÇ: Bu yazýda kardiyak patoloji nedeniyle kardiyoloji ve kalp damar cerrahisi kliniklerinde antikoagülan ve antiagregan tedavisi altýnda spontan geliþen rektus kýlýf hematomunun mortalite ile iliþkisi sunuldu.
GEREÇ VE YÖNTEM: Ocak 2010 ve Aralýk 2015 tarihleri arasýnda Kartal Koþuyolu Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi’nde spontan rektus kýlýf hematom tanýlý 27 hasta geriye dönük olarak deðerlendirildi.
BULGULAR: Hastalarýn 19’u (%70.4) kadýn, sekizi (%29.6) erkek olup yaþ ortalamalarý 63±12 (daðýlým, 32- 84) yýldý. Hastalarýn tamamýnda en az bir olmak üzere takip gerektiren ek hastalýk mevcuttu. Hastalarýn 14’ü sadece antikoagülan tedavi, sekizi sadece antiagregan tedavi ve geri kalan beþ hasta ise hem antikoagülan hem de antiagregan tedavi almaktaydý. Fizik muayenede olgularýn tümünde karýn alt kadranlarýnda aðrýlý palpabl kitle vardý. Bilgisayarlý tomografideki boyut ve lokalizasyona göre tiplendirildiðinde olgularýn yedisi Tip 1, altýsý Tip 2, 14’ünün ise Tip 3 olduðu saptandý. Olgularýn 23’üne týbbi tedavi uygulanýrken geriye kalan dört hastayada cerrahi tedavi uygulandý. Sekiz (%29.6) hastada mortalite izlendi.
TARTIÞMA: Sonuç olarak, rektus kýlýf hematomu nadir olup kardiyak nedenlerle antikoagülan ve antiagregan alan hastalarda sýklýðý artmaktadýr. Kardiyak nedenlerle hastane yatýþý esnasýnda rektus kýlýf hematomu geliþen, ek hastalýklarý olan ve hastanede kalýþ süresinin uzamasý nedeniyle ek komplikasyonlar geliþen hastalarda mortalite önemli ölçüde artmaktadýr.