Abstract
A 68-year-old man admitted to a nearby hospital for exacerbated rheumatoid arthritis 1 month earlier suffered melena when the steroid dose was gradually increased. Hemorrhage from the ascending colon diverticulum was diagnosed and endoscopic hemostasis conducted. An IVH catheter was inserted via the right femoral vein, and hyperalimentation and blood transfusion were started. Four days later, right lower abdominal pain occurred and the patient was referred to our department. Localized tenderness was noted in the right rectus abdominis muscle, but not fever or peritoneal irritation signs. WBC was 18, 100/μ/ and CRP was 0.47mg/dl. Ultrasonography showed a heterogenous internal echo and a lens-like right rectus abdominis muscle. Computed tomography imaged gas and a foreign body within the rectus sheath, suggesting hematoma or abscess in the rectus abdominis muscle and necessitating surgery. An IVH catheter was found to have strayed into the rectus sheath. This rare case involved an IVH catheter inserted via the right femoral vein reaching the inferior epigastric vein, puncturing the vessel and causing necrosis of the rectus abdominis muscle.
