Is conservative management of spontaneous rectus sheath hematoma effective?

Objective: Spontaneous rectus sheath hematoma is a rare and often overlooked cause of acute abdominal pain. In this study, we aimed to present the results of patients with rectus sheath hematoma who received conservative treatment.
Materials and Methods: In this study, the demographic data, complaints, medical history, and data pertaining to the treatment provided to 9 patients were retrospectively retrieved from the computerized patient record system and imaging archives. The included patients presented with abdominal pain to our hospital’s emergency room between January 2010 and 2016, were diagnosed with spontaneous rectus hematoma, and received conservative treatment.
Results: The female/male ratio of the 9 patients who participated in this study was 1: 2, and the average age was 48.8 years. All the patients were admitted to the emergency department with abdominal pain. Three patients had a history of oral anticoagulant use, 3 patients had a history of hypertension, and 1 patient had a history of chronic obstructive pulmonary disorder. No predisposing factor was detected in the other 2 patients. There was a history of severe cough in 4 patients prior to their complaints; however, there was no history of coughing, trauma, or a surgery that would lead to this condition in the other patients. Five of the 9 patients received conservative treatment as inpatient treatment for rectus hematoma, while 4 patients received it as outpatient treatment. The average duration of hospital stay of the patients was 3 days. A cerebrovascular infarction that did not cause permanent damage developed in 1 patient 2 weeks after discharge. No additional morbidity or mortality was observed in any of the other patients.
Conclusion: Spontaneous rectus sheath hematoma should be considered in the differential diagnosis of abdominal pain that occurs after a persistent cough, particularly in patients receiving anticoagulant therapy. It is thought that the cases respond well to conservative treatment for etiology.

Spontan rektus hematomlarýnda konservatif yaklaþým baþarýlý mý?

Amaç: Spontan rektus kýlýf hematomu akut karýn aðýsýnýn nadir görülen ve sýklýkla gözden kaçan bir nedenidir. Bu çalýþmamýzda rektus kýlýf hematomu nedeniyle konservatif tedavi uyguladýðýmýz hastalarýmýza ait sonuçlarýmýzý sunmayý amaçladýk.
Gereç ve Yöntem: Çalýþmamýzda Ocak 2010 - 2016 tarihleri arasýnda hastanemiz acil servisine karýn aðrýsý þikayeti ile baþvuran, spontan rektus hematomu tanýsý konulup konservatif tedavi uygulanan 9 hastanýn demografik verileri, baþvuru þikayetleri, týbbý geçmiþleri ve uygulanan tedaviye ait veriler retrospektif olarak hasta dosyasý, bilgisayar kayýt sistemi ve görüntüleme arþivlerinden tarandý.
Bulgular: Çalýþmaya katýlan 9 hastanýn K/E oraný 1/2 olup ortalama yaþ 48.8 yýl idi. Hastalarýn hepsi acil servise karýn aðrýsý þikayeti ile baþvurdu. Özgeçmiþlerinde 3 hastada oral antikoagulan kullanýmý, 3 hastada hipertansiyon, bir hastada da kronik obstrüktif akciðer hastalýðý öyküsü mevcut iken diðer iki hastada herhangi bir predispozan faktör saptanmadý. Toplam 4 hastada þikayetlerinden önce þiddetli öksürük hikayesi olduðu öðrenildi, diðer hastalarda bu duruma neden olabilecek öksürük, travma veya bir operasyon öyküsü yoktu. Rektus hematomu tanýsý alan 5 hastaya yatarak, 4 hastaya da ayaktan takip ile konservatif tedavi uygulandý. Hastalarýn ortalama yatýþ süresi 3 gündü. Bir hastada taburcu edildikten 2 hafta sonra kalýcý hasar býrakmayan serebrovasküler enfarktüs geliþti. Diðer hastalarýn hiçbirinde ek morbidite ve mortalite gözlenmedi.
Sonuç: Spontan rektus kýlýf hematomu özellikle antikoagulan tedavi alan hastalarda, öksürük nöbetinden sonra oluþan karýn aðrýsý þikayetinde ayýrýcý tanýda göz önüne alýnmalýdýr. Vakalarýn etyolojiye yönelik yapýlan konservatif tedaviye iyi cevap verdiði düþünülmektedir.