Rectus Sheath Hematoma: Three Case Reports

Selin Kapan; Ahmet N Turhan; Halil Alis; Mustafa U Kalayci; Sinan Hatipoglu; Hakan Yigitbas; Ersan Aygun


J Med Case Reports 

In This Article

Abstract and Introduction


Introduction: Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen.

Case Presentation: We reported three cases of rectus sheath hematoma presenting with a mass in the abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment.

Conclusion: Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.


Rectus sheath hematoma is accumulation of blood in the sheath of rectus abdominis muscle due to disruption of epigastric vessels or rectus muscle.[1] Although the etiology includes trauma, abdominal operations, trocar site injury after laparoscopic operations, subcutaneous drug injections, anticoagulant therapy, hematological diseases, hypertension, coughing, physical exercise, pregnancy, it rarely occurs spontaneously.[1,2,3,4,5] It usually occurs in the lower quadrants of the abdominal wall and almost never crosses the midline.[1,2,6] Hematoma below the linea semicircularis causes an indirect irritation on the peritoneum due to weak posterior rectus sheath in this region leading to misdiagnoses as acute abdomen.[1,2]

Three consecutive cases presenting to our Emergency Department in the past 2 months are reported in this paper regarding the accurate diagnosis and management.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: