Diagnostic and management of spontaneous rectus sheath hematoma
| Autor: | Jessica Ruiz, Marta Valverde, Rafael Perelló, Javier Ramos, Luïsa Garzo, Alex Smithson |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Abdominal pain medicine.drug_class medicine.medical_treatment Rectus Abdominis Low molecular weight heparin Cohort Studies Internal Medicine Humans Medicine Embolization Rectus sheath hematoma Aged Retrospective Studies Ultrasonography Aged 80 and over Hematoma medicine.diagnostic_test business.industry Anticoagulants Rectus sheath Middle Aged medicine.disease Embolization Therapeutic Epigastric Arteries Abdominal mass Abdominal Pain Surgery Treatment Outcome medicine.anatomical_structure Abdominal ultrasonography Hypertension Female Radiology medicine.symptom Tomography X-Ray Computed business Abdominal surgery |
| Zdroj: | European Journal of Internal Medicine. 24:579-582 |
| ISSN: | 0953-6205 |
| Popis: | Background Spontaneous rectus sheath hematoma is an uncommon and often misdiagnosed cause of abdominal pain. The aim of this study is to describe our experience in their management. Methods Retrospective analysis of the characteristics and outcomes of the spontaneous rectus sheath hematomas diagnosed over the last 12 years was conducted. Results 24 patients were included (66% women; mean age: 74 years; range: 54–87). All cases presented predisposing factors mainly anticoagulant therapy in 21 (87.5%) patients, hypertension in 19 (79.1%) and abdominal surgery in 12 (50%) cases. Eighteen (75%) referred triggering factors like coughing being the most common one, present in 17 (70.8%) patients. The main clinical findings were abdominal pain in 21 (87.5%) cases and the existence of an abdominal mass in 20 (83.3%). The diagnosis was confirmed by abdominal ultrasonography and/or computerized tomography in 23 (95.8%) patients. Nineteen cases (79.1%) responded to conservative management while 5 (20.8%) required interventional treatment, which consisted in an arteriography with selective embolization of the epigastric arteries in all cases. Four (80%) of the patients needing interventional treatment were receiving low molecular weight heparin. Nine (37.5%) patients developed hypovolemic shock and 1 (4%) died. Conclusions Spontaneous rectus sheath hematomas should be considered in the differential diagnosis of abdominal pain, particularly in elderly women under anticoagulant therapy with onset of symptoms after a bout of cough. Most cases respond to conservative management, although those related to low molecular weight heparin might require interventional treatment; arteriography with selective embolization of the epigastric arteries is the first therapeutic option. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect