Introduction
Rectus sheath hematoma (RSH) is a rare cause of stomach ache which is underestimated and has significant morbidity and mortality.1 RSH is the accumulation of blood in the anterior rectus sheath due to rupture of the epigastric veins or the rectus muscle.1 It is recognized as a “diagnostic dilemma” as it can be easily confused with the etiology of many acute abdominal pains.2 RSH is characterized by presence of a palpable abdominal mass characterized by acute abdominal pain following abdominal muscle strain that is caused by trauma, coughing, sneezing etc. 3
Many cases are referred to as spontaneous rectus sheath hematoma because they do not have a trauma history. Oral anticoagulation therapy or anticoagulant therapy administered with low molecular weight heparin are recognized as the most common risk factors known to be associated with spontaneous rectus sheath hematoma. Pregnancy, hypertension, previous abdominal surgery, coagulopathies or anti-platelet therapy have also been defined as risk factors. 1,4-6 Incidence of spontaneous rectus sheath hematoma (SRHS) increases upon increased administration of antiplatelet and anticoagulant therapies, and the estimated annual rate of SRSH is 1.2% to 1.5%.7
Early diagnosis and treatment are necessary in SRSH to minimize complications such as hemodynamic instability, abdominal compartment syndrome, multiple organ dysfunction syndrome, and death. Treatment options include conservative, interventional and surgical methods. Surgery might be fatal for many patients with RSH because they have other morbidities and hermorrhagic diathesis in advanced age. Therefore, the surgeon must be aware of the method that will best suit the patient. Hematoma might restrain itself with the help of conservative treatments like bed rest, analgesia, and correction of the bleeding disorder in many cases. Mortality can reach 4% even if SRSH restrains itself with the help of conservative treatment, and it can reach 25% in patients using anticoagulants. Radical interventions are required when conservative treatment modalities fall short.7
In the literature, data relating to rectus sheath hematoma are based on single center experiences and series with limited number of patients.3,7-10
In this study; we aim to analyze and discuss, in the light of the literature, the clinical features of patients diagnosed with rectus sheath hematoma in our clinic over a period of 10 years, and the therapeutic management and therapeutic results of SRSH.