Timing of Anticoagulation Resumption After Spontaneous Rectus Hematoma

Abstract

Objective:Rectus sheath hematoma (RSH) is a rare condition characterized by acute abdominal pain and development of a mass on the abdominal wall. It is caused by bleeding resulting from the rupture of one of the inferior epigastric arteries or a tear in the rectus muscle. It is associated with trauma and anticoagulant usage. Although there have been no substantial advancements in the diagnosis and treatment of RSH in recent years, it is anticipated that the incidences of RSH will increase with the rising use of anticoagulants. Surgery is rarely performed, but patients are monitored in general surgery departments. Treatment requires maintaining a delicate balance between the risks of bleeding and thrombosis. This study aims to present nontraumatic RSH cases treated in our clinic, supported by a review of the literature. Methods: This retrospective multicenter study included patients over 18 years of age who were admitted with a diagnosis of nontraumatic RSH between 2020 and 2021 at the Department of General Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, and the General Surgery Clinic of Kayseri City Hospital. Patients diagnosed with RSH were identified by reviewing clinical protocol records and digital databases. The demographic data of the patients, such as age and gender, physical examination findings at admission, medications used, comorbidities, complete blood count, international normalized ratio and other laboratory information, imaging methods used for diagnosis, and receipt and quantity of blood products, were recorded. Following diagnosis, patients were monitored for one month for bleeding (recurrent bleeding, gastrointestinal bleeding, and intracranial bleeding) and thrombotic complications (heart valve thrombosis, cerebrovascular events, and pulmonary embolism). Results: Of the 32 patients included in the study, 24 were men (75%) and eight were women (25%). Abdominal pain and palpable swelling were common complaints in all patients. Patient age ranged between 27 and 92 years with a mean age of 70.6 ± 12.9 years. Mean length of hospital stay was 12.6 ± 12.0 days, and 28% of the patients stayed in the intensive care unit for a mean duration of 2.8 ± 6.3 days. Correlation analysis revealed a weak positive correlation between the size of the hematoma on imaging and length of hospital stay and a weak negative correlation between Hb value at diagnosis and length of hospital stay (p = 0.017 and r = 0.426). Conclusion: Nontraumatic RSH is a potentially fatal condition that requires hospitalization and intensive care unit admission as well as substantial amounts of blood transfusion. There is a relationship between the imaging method used at admission and the length of hospital stay as well as the hemoglobin level of the patient.

Keywords

• Anticoagulant
• Rectus sheath hematoma
• Initiation

References

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