Spontaneous rectus sheath hematoma: an analysis of 15 cases

BACKGROUND
Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.
METHODS
This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).
RESULTS
All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.
CONCLUSION
Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

Spontan rektus kýlýf hematomu: 15 olgunun analizi

AMAÇ
Spontan rektus kýlýf hematomu (RKH) akut karýn aðýsýnýn sýklýkla gözden kaçan nadir bir nedenidir. Bu çalýþmada, spontan RKH’nin taný ve tedavisindeki tecrübelerimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM
Bu çalýþmada, Ocak 2000-Temmuz 2009 tarihleri arasýnda acil cerrahi polikliniðine baþvuran ve spontan RKH tanýsý alan 15 hastanýn (12 kadýn, 3 erkek; ortalama yaþ 64,5 yýl; daðýlým 20-79 yýl) týbbi kayýtlarý retrospektif olarak incelendi.
BULGULAR
Tüm olgularýn baþvuru nedeni akut karýn aðrýsý ve/veya karýnda kitle idi. Toplam 11 olgu (%73) antikoagülan ve/veya antiagregan tedavisi almaktaydý. Antikoagülan/antiagregan tedavisin endikasyonlarý arasýnda en sýk olanlarý 5 hastada (%33) atriyel fibrilasyon ve 3 hastada (%20) mitral kapak replasmaný yer almakta idi. Taný 14 olguda (%93) karýn ultrasonografisi ve/veya bilgisayarlý tomografi ile kondu. Hastalarýn 12’si (%80) ortalama 8,8 gün (daðýlým 3-24 gün) yatýþ süresi sonrasý konservatif tedavi ile sorunsuz bir þekilde taburcu edildi. Mortalite oraný %20 idi.
SONUÇ
Akut karýn aðrýsý ile baþvuran ve antikoagülan tedavisi almakta olan ileri yaþ hastalarýnda spontan RKH’den þüphe edilmelidir. Erken taný konservatif tedaviye olanak saðlayarak gereksiz cerrahi giriþimleri önler.