TWO CASES OF SPONTANEOUS RECTUS SHEATH HEMATOMA

Abstract

We here report two cases of spontaneous rectus sheath hematoma. Case 1 involved a 72-year-old man, who had been in our hospital for purpose of PTCA for ischemic heart disease and underwent anticoagulant therapy. There was a previous history of undergoing an appendectomy. After repeated coughs, suddenly he complained of severe right hypogastric pain. Abdominal palpation, laboratory data and abdominal CT did not lead us to make the correct diagnosis. We performed an operation under general anesthesia. suspecting some of acute abdomen and found a huge hematoma in the musculus rectus abdominis. Case 2 involved a 66-year-old woman who had suffered from liver cirrhosis and diabetes meliltus. After repeated coughs, like in Case 1, suddenly she complained of a severe left hypocondrial pain. We could easily diagnosed her as having a spontaneous rectus sheath hematoma from abdominal CT, abdominal ultrasonography and the experience with case 1, and performed drainage of the hematoma under local anesthesia. Spontaneous rectus sheath hematoma is a relatively rare entity and often present difficulty in differentiation from acute abdomen because of its abrust onset and severe pain. It is thought that the difficulty in diagnosis of the disease may depend on that we have experienced the case of the disease or not. We have to entertain the presence of the disease as a probable diagnosis.