Abstract
Aim: We reviewed the clinical features, treatment, and
outcomes of 17 patients diagnosed with Rectus Sheath Hematoma.
Material method: In this
observational study, patients diagnosed with RSH in Akdeniz University chest
diseases clinic from December 31, 2012, to December 31, 2016 were investigated. RSH was confirmed by
radiological investigations. Demographic
characteristics, clinic features and comorbidities, physical examination leading to diagnosis,
laboratory study results , imaging methods, treatment, and outcomes of 17 patients diagnosed with
RSH were investigated.
Results :Twelve (70.5%) female and
5 (29.5%) male were followed up due to RSH in our Chest Diseases Clinic between
December 2012 and December 2016. The mean age of all cases was 72.9 (range of
distribution 42-89), while the mean age of female patients was 73.0 (range
54-87) and male 72.2 (range 42-89). The most common presenting symptoms were
abdominal pain (14 cases), hematuria (2 cases)
and a case of groin pain. All
patients received anticoagulant treatment (11 enoxaparin sodium, 4 warfarin
sodium, 1 rivaroxaban) except one. The
diagnosis of RSH was confirmed by ultrasonography in 13 cases and computerized
tomography in 3 other cases. Conservative treatment response was obtained in 11
of the patients, while 6 patients developed hypotensive shock and died.
Conclusion : Rectus sheath hematoma should be considered in the diagnosis of
acute sepsis in patients with subclass low molecular weight heparin (LMWH)
treatment and sudden onset of mass. RSH is more common in women and in patients
using anticoagulants.
Keywords
References
- 1.Berna JD, Zuazu I, Madrigal M,et al. Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging 2000;25:230-4.2.Karakaş K, Çalış H, Demirtaş T et al. Rectus kılıfı hematomu. Ankara Üniversitesi Tıp Bülteni.1988; 20(4):733-7.3. Klingler PJ, Wetscher G, Tschmelitsch J, et al. The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disor¬ders. Surg Endosc 1999;13:1129-34.4. Dubinsky IL. Hematoma of the rectus abdominis muscle: case report and review of the literature. The J Emerg Med 1997;15:165-7.5. Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: A review of the literature. International Journal of Surgery 2015;13: 267-71.6. Gölcük Y, Oray D, Bademkıran E. Type III Rectus Sheath Hematoma: A Case Report. Tr J Emerg Med 2012;12(1):38-40.7. Bownik H, Afsar-manesh N, Jakoi A. A growing problem: A case of rectus sheath hematoma. Proseedings of UCLA Healthcare 2010;14:1-4.8. Cherry WB, Mueller PS. Rectus Sheath Hematoma Review of 126 Cases at a Single Institution. Medicine 2006;85:105–10.9. Erkuran MK, Duran A, Kaya M, Kaptan HM. A Case of Abdominal Pain: Rectus Sheath Hematoma. İKSST Derg 8(2):111-113, 201610. Fothergill WF. Hematoma in the abdominal wall simulating plevic new growth. The British Med J. 1926 ;1:941-2.11. DeLaurentis D, Rosemond G. Hematoma of the rectus abdominis muscle complicated by anticoagulation therapy. Am J Surg 1996;112:859-63.12. Sandoval O, Kinkead T. Spontaneous Rectus Sheath Hematoma:An Unusual Cause of Gross Hematuria. UROLOGY 2013;82: 35-36.13. Firoozbakhsh S, Parsaei R, Jafarshad R. Hematoma of rectus sheath following subcuatenous enoxaparin injection. Acta Medica Iranica, 2013; 51:334-6.14. Mantelas M, Katsiki N, Antonitsis P et al. Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach. The Open Cardiovascular Medicine Journal, 2011:5, 4-5.15. Tsapatsaris NP. Low-dose heparin: a cause of hematoma of rectus abdo¬minis. Arch Intern Med 1991;151:597-9.
Abstract
Amaç: Rektus Kılıf Hematomu (RKH) tanısı koyduğumuz 17 olgu nedeniyle, RKH’ nun etyolojisi, klinik belirti ve bulguları ile güncel tanı yöntemlerini irdeledik.
Yöntem: Aralık 2012-Aralık 2016 yılları arasında Göğüs Hastalıkları Kliniğimizde RKH tanısı alan hastalar retrospektif gözlemsel olarak incelendi. Olguların demografik özellikleri, özgeçmişleri ve yakınmaları, tanıya götüren fiziksel inceleme, laboratuvar ve görüntüleme yöntemlerindeki bulgular ve tedavi yöntemleri araştırıldı.
Bulgular: Aralık 2012-Aralık 2016 yılları arasında 12 (%70.5)’si kadın ve 5 (%29.5)’i erkek olmak üzere toplam 17 hastanın RKH tanısı aldığı tespit edildi. Tüm olguların yaş ortalaması 72.9 ± 12.4 iken, kadın hastalar ortalama 75.5±9.8 yaşında, erkek hastalar 66.6±16.8 yaşında idi. Olgularda en sık yakınma karın ağrısı (14 olguda) iken iki olguda idrarda kan gelme şikayeti ve bir olguda kasık ağrısı yakınması mevcuttu. Onaltı olgu antikoagulan tedavi (11’i enoksaparin sodyum, 4’ü varfarin sodyum,1’i rivaroksaban) almışken, bir olgu ise herhangi bir antikoagulan ya da antiagregan tedavi almamıştı. RKH tanısı 13 olguda ultrasonografi ile diğer 3 olguda bilgisayarlı tomografi ile doğrulanmıştı. Tedavi olarak olguların tümünde antikoagülan tedavi kesildi, tam kan ve parasetamol verildi. Hastaların 11’inde konservatif tedaviye yanıt alınırken, 6 olgu hipotansif şok gelişerek kaybedildi.
Sonuç: Subkutan düşük molekül ağırlıklı heparin (DMAH) tedavisi uygulanan ve batında ani gelişen kitlesi olan hastalarda, akut batın ayırıcı tanısında, RKH akla gelmelidir. RKH kadınlarda ve antikoagülan kullanan hastalarda daha sık görülmektedir.
References
- 1.Berna JD, Zuazu I, Madrigal M,et al. Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging 2000;25:230-4.2.Karakaş K, Çalış H, Demirtaş T et al. Rectus kılıfı hematomu. Ankara Üniversitesi Tıp Bülteni.1988; 20(4):733-7.3. Klingler PJ, Wetscher G, Tschmelitsch J, et al. The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disor¬ders. Surg Endosc 1999;13:1129-34.4. Dubinsky IL. Hematoma of the rectus abdominis muscle: case report and review of the literature. The J Emerg Med 1997;15:165-7.5. Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: A review of the literature. International Journal of Surgery 2015;13: 267-71.6. Gölcük Y, Oray D, Bademkıran E. Type III Rectus Sheath Hematoma: A Case Report. Tr J Emerg Med 2012;12(1):38-40.7. Bownik H, Afsar-manesh N, Jakoi A. A growing problem: A case of rectus sheath hematoma. Proseedings of UCLA Healthcare 2010;14:1-4.8. Cherry WB, Mueller PS. Rectus Sheath Hematoma Review of 126 Cases at a Single Institution. Medicine 2006;85:105–10.9. Erkuran MK, Duran A, Kaya M, Kaptan HM. A Case of Abdominal Pain: Rectus Sheath Hematoma. İKSST Derg 8(2):111-113, 201610. Fothergill WF. Hematoma in the abdominal wall simulating plevic new growth. The British Med J. 1926 ;1:941-2.11. DeLaurentis D, Rosemond G. Hematoma of the rectus abdominis muscle complicated by anticoagulation therapy. Am J Surg 1996;112:859-63.12. Sandoval O, Kinkead T. Spontaneous Rectus Sheath Hematoma:An Unusual Cause of Gross Hematuria. UROLOGY 2013;82: 35-36.13. Firoozbakhsh S, Parsaei R, Jafarshad R. Hematoma of rectus sheath following subcuatenous enoxaparin injection. Acta Medica Iranica, 2013; 51:334-6.14. Mantelas M, Katsiki N, Antonitsis P et al. Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach. The Open Cardiovascular Medicine Journal, 2011:5, 4-5.15. Tsapatsaris NP. Low-dose heparin: a cause of hematoma of rectus abdo¬minis. Arch Intern Med 1991;151:597-9.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | March 2, 2020 |
| Acceptance Date | November 20, 2018 |
| Published in Issue | Year 2020 Volume: 12 Issue: 1 |