The changing nature of rectus sheath haematoma: case series and literature review.

BACKGROUND: Rectus sheath haematoma (RSH) is classically described as a rare condition, following a relatively benign course. Notable in its' diagnostic difficulty, RSH may mimic a wide range of other more serious pathologies. With the advent of computed tomography (CT) scanning misdiagnosis is now less common. However, a number of recent case reports suggest the frequency and severity of cases is increasing. This case series examines our experience of RSH, and reviews the changing presentation and management of this condition.
METHODS: Retrospective review of a prospectively maintained patient database, including all patients with discharge diagnosis of RSH over 30-month period. An additional two cases were noted prospectively. Clinical notes were reviewed and linked to radiological imaging.
RESULTS: Seven patients were identified (3 female, 4 male; median age 76, range 27-89) during the review period. Two patients were haemodynamically compromised at presentation, with significant tachycardia in two others. One patient had an unknown bleeding diathesis, whilst the remainder were all prescribed anticoagulant medication. Three patients required fluid resuscitation and blood transfusion. The correct diagnosis was only made in two patients prior to imaging. All patients underwent confirmatory CT scanning.
CONCLUSION: This case series indicates the increasing prevalence and severity of rectus sheath haematoma, largely due to increased use of anticoagulant medication in an aging population. Our findings emphasise the changing nature of the condition, together with the variable clinical courses it may take. Clinicians must treat this condition expectantly and be aware of complications that may ensue.