Behzad Nematihonar1, Shohra Qaderi2,3, Jaffer Shah4, Javad Zebarjadi Bagherpour5. 1. Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341, Iran. 2. Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Medical Research Center, Kateb University, Kabul, Afghanistan. 4. Drexel University College of Medicine, Philadelphia, PA, USA. 5. Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341, Iran. javad.zebarjady@yahoo.com.
Abstract
INTRODUCTION: Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. PRESENTATION OF CASES: (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up. DISCUSSION: Hemorrhagic issues in COVID-19 patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19 patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery. CONCLUSIONS: These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19 infection.
INTRODUCTION:Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. PRESENTATION OF CASES: (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up. DISCUSSION: Hemorrhagic issues in COVID-19patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery. CONCLUSIONS: These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19infection.