Spontaneous Rectus Sheath Hematoma Expanding into the Pelvic Retroperitoneum in a Patient Receiving Antithrombotic Therapy

Abstract

A 79-year-old woman who received an antithrombotic agent for a chronic myeloproliferative disorder complained of abdominal pain and nausea from the previous day and was admitted to our hospital. Abdominal computed tomography showed a giant hematoma expanding from the lower rectus abdominis muscle into the pelvic retroperitoneum. Emergency surgery was performed with the diagnosis of intraabdominal bleeding, gradual worsening of anemia, and decreasing blood pressure. Bleeding from a ruptured left inferior epigastric artery was found, and a rectus sheath hematoma expanding into the pelvis was diagnosed. The artery was ligated and the hematoma was removed. The patient was discharged and had no serious postoperative complications, except for hemorrhagic gastric ulceration. Recognition of the factors predisposing to such a hematoma in aging patients and those receiving antithrombotic therapy is important.