Images in Clinical Medicine

Hematoma of the Rectus Sheath

David R. Gutknecht, M.D.

N Engl J Med 2003; 348:1455April 10, 2003

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A 79-year-old woman who was taking warfarin and enoxaparin because of deep venous thrombosis reported abdominal pain after coughing. On physical examination, a mass was felt in the left side of the abdomen. Computed tomography (CT) showed blood in the left rectus sheath, with thickening of the left upper abdominal wall, and a fluid–fluid level (arrowhead) within a mass (arrow) in the midabdomen (Panel A). The hemoglobin level was 9.7 g per deciliter, and the prothrombin time was 24.9 seconds (international normalized ratio, 3.3). Anticoagulant treatment was discontinued, but the mass enlarged, and three days later CT scanning showed extension of the hematoma into the pelvis (Panel B, arrow). This extension may have been due to the absence of a confining fascia in the lower abdomen. The patient received fresh-frozen plasma and red cells. She was discharged in improved condition.

David R. Gutknecht, M.D.
Geisinger Medical Center, Danville, PA 17822-1401

Citing Articles (3)

Citing Articles

1. 1

   Adnan Taş, Erdem Akbal, Erdem Koçak, Seyfettin Köklü, Ömer Yılmaz, Aynur Turan. (2010) Abdominal pain due to rectus abdominis muscle haematoma associated with anticoagulant therapy. Emergency Medicine Australasia 22:3, 252-253
   CrossRef

2. 2

   Leonardo Di Ascenzo, Matteo Cassin, Mauro Driussi, Michele Moretti, Rosa Pecoraro, Gian Luigi Nicolosi. (2008) Major rectus abdominis hematoma complicating low molecular weight heparin therapy. Journal of Cardiovascular Medicine 9:7, 758-759
   CrossRef

3. 3

   Virginie Siguret, Eric Pautas, Isabelle Gouin. (2004) Low molecular weight heparin treatment in elderly subjects with or without renal insufficiency: new insights between June 2002 and March 2004. Current Opinion in Pulmonary Medicine 10:5, 366-370
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