A CASE OF SPONTANEOUS RECTUS SHEATH HEMATOMA

Abstract

A case of spontaneous rectus sheath hematoma caused by cough is reported. A 72-year-old woman was admitted to the hospital because of right abdominal pain and nausea immediately after cough. Tenderness and peritoneal irritable sign were recognized on the entire right abdomen, but no sign was recognized on the left side. Since abdominal CT showed an iso and high density lens shaped mass like lesion in the right rectus sheath, it was diagnosed as right rectus sheath hematoma. She recovered by conservative therapy within 40 days. We discussed the characters of this disease in Japanese 37 cases reported in a recent one decade. Spontaneous rectus sheath hematoma is relatively rare, a mean age is 58.6 years old and 78.4% of all cases are women. This disease has often peritoneal irritable sign, but conservative therapy is effective fundamentally. In the diagnosis, if spontaneous rectus sheath hematoma is not considered, unnecessary laparotomy would be sometimes performed, and abdominal ultrasonography, CT and magnetic resonance imaging are so useful for diagnosis of this disease. We were able to avoid unnecessary laparotomy in this case.