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RECTUS SHEATH HEMATOMA MIMICKING INGUINAL HERNIA

Tarig Abdelhafiz, Abdullah Saleh Almuslam, Mohammed Kamal Al Adi, Abdaljaleel Shaker Abualsaud, Mohammed Jawad AlQassim

Introduction: Rectus sheath hematoma (RSH) is an uncommon condition that results from accumulation of blood within the rectus sheath and causes acute abdominal pain. It accounts for 1.8% of acute abdomen cases. Female gender and old age are known risk factors. It usually presents with abdominal pain and tender swelling. Case presentation: We report a case of a 49 years old male, known case of hypertension, status post thoracic aorta dissection repair 7 years prior to presentation, on warfarin, presented with abdominal pain and inguinal swelling for 4 days. Abdominal examination revealed a swelling at the right inguinal area with multiple bruises and positive cough impulse. All labs were within normal except prolonged INR of 2.01 . US scan showed an incarcerated inguinal hernia, however CT scan showed RSH. Patient was managed conservatively and discharged after 4 days. Discussion: RSH is a rare cause of acute abdomen. Most common risk factors are anticoagulant therapy, female gender and trauma. Our patient was a young male, with no history of trauma. RSH usually presents with abdominal pain and swelling at the course of the rectus muscle. US and CT scan are the diagnostic modalities of choice with the latter being more sensitive and specific. Management of RSH depends on the stability of the patient. Our patient was managed conservatively. Surgery is usually reserved for hemodynamically unstable patients with uncontrolled bleeding. Conclusion: Although rectus sheath hematoma is an uncommon cause of acute abdomen, it should be considered in the differential diagnosis in patients using anticoagulants presenting with abdominal pain and swelling. US can be done initially, however CT scan is the gold standard radiological investigation. Conservative management remains the management option of choice for stable patients.

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