Spontaneous hematoma of the rectus sheath following percutaneous transluminal coronary angioplasty and stent placement
Rodolfo Mendes Queiroz, Fred Bernardes Filho
The Pan African Medical Journal. 2018;30:88. doi:10.11604/pamj.2018.30.88.15000

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Spontaneous hematoma of the rectus sheath following percutaneous transluminal coronary angioplasty and stent placement

Cite this: The Pan African Medical Journal. 2018;30:88. doi:10.11604/pamj.2018.30.88.15000

Received: 28/01/2018 - Accepted: 19/05/2018 - Published: 30/05/2018

Key words: Hematoma, abdominal pain, percutaneous transluminal coronary angioplasty

© Rodolfo Mendes Queiroz et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/30/88/full

Corresponding author: Fred Bernardes Filho, Department of Radiology and Imaging, Santa Casa da Misericórdia of Avaré, Avaré, São Paulo, CENTROMED Diagnóstico por Imagem, Avaré, São Paulo, Brazil (f9filho@gmail.com)


Spontaneous hematoma of the rectus sheath following percutaneous transluminal coronary angioplasty and stent placement

Rodolfo Mendes Queiroz1,2,&, Fred Bernardes Filho3

 

1Department of Radiology and Imaging, Santa Casa da Misericórdia of Avaré, Avaré, São Paulo, Brazil, 2CENTROMED Diagnóstico por Imagem, Avaré, São Paulo, Brazil, 3Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil

 

 

&Corresponding author
Fred Bernardes Filho, Department of Radiology and Imaging, Santa Casa da Misericórdia of Avaré, Avaré, São Paulo, CENTROMED Diagnóstico por Imagem, Avaré, São Paulo, Brazil

 

 

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A 74-year-old female with hypertension, coronary artery disease, was hospitalized due to an acute myocardial infarction. A percutaneous transluminal coronary angioplasty (PTCA) and stenting were performed successfully. After six hours of PTCA, an intense abdominal pain localized on right iliac fossa started. On physical examination, a palpable, painful, firm, nonpulsatile abdominal mass was observed. Fothergill’s and Carnett’s signs were present; there were not Cullen's and Grey Turner's signs. Abdominal computed tomography (CT) showed oval collection, isodense in relation to the muscular planes, located in almost all the extension of the rectus abdominis muscle on the right, measuring in its greater axial axes 8.6 x 6.0 cm. Patient did not present drop of the hemoglobin levels nor hemodynamic instability. The diagnosis of hematoma of the rectus sheath was performed and conservative management was elected. Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain and can be life threatening if diagnosis and management is delayed. RSH occurs due to the accumulation of blood within the rectus abdominis sheath secondary to bleeding from damaged inferior or superior epigastric arteries, or through direct tears of the rectus abdominis muscle. Abdominal pain and fall in hemoglobin with presence of risk factors (especially systemic anticoagulation drugs like warfarin and intravenous heparin) constitute important clinical clues to the diagnosis. Management is guided by the size of the haematoma and haemodynamic stability of the patient. Clinicians should consider RSH in the differential diagnosis of acute abdominal pain.

 

 

Figure 1: computed tomography of abdomen showing hematoma (arrow) within rectus sheath; L: left; R: right

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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Keywords

Hematoma
Abdominal pain
Percutaneous transluminal coronary angioplasty

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