Spontaneous Haematoma of the Anterior Rectus Abdominis Muscle

Abstract Introduction Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. Methods A retrospectiv...

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Bibliographic Details
Published in:Cirugia española (English ed.) 2016-05, Vol.94 (5), p.294-299
Main Authors: Mendoza Moreno, Fernando, Díez Alonso, Manuel, Villeta Plaza, Rafael, Minaya Bravo, Ana María, Ovejero Merino, Enrique, Córdova García, Diego Martín, Granell Vicent, Javier
Format: Article
Language:English
Subjects:
Anticoagulant therapy
Computed tomography
Diagnosis
Diagnóstico
Embolización arterial
Haematoma
Hematoma
Management
Rectus sheath
Surgery
Terapia anticoagulante
Tomografía computarizada
Transcatheter embolisation
Tratamiento
Vaina rectos
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Summary:Abstract Introduction Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. Methods A retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous haematoma of the abdominal rectus muscle between March 2003 and December 2014. Results The study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty-eight patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolisation. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. Conclusion Spontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolisation.
ISSN:2173-5077
2173-5077
DOI:10.1016/j.cireng.2016.05.006