Rectus Sheath Hematoma Differential Diagnoses

Updated: Dec 29, 2020
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
  • Print

Diagnostic Considerations

Important considerations

Recognize, diagnose, and manage rectus sheath hematoma (RSH).

Obtain a surgical consultation for patients with large or expanding hematomas, for patients who are hemodynamically unstable, for those requiring transfusions, or for those undergoing anticoagulation therapy.

Reverse anticoagulation in patients with expanding hematomas, symptomatic anemia, or hemodynamic instability.

Maintain adequate anticoagulation in patients at high risk for intravascular thrombosis with small stable rectus sheath hematomas.

Provide fluid resuscitation and transfusion with packed red blood cells if indicated by hemodynamics, comorbidities, or significant anemia.

Other conditions to consider

Other conditions to consider in patients with suspected rectal sheath hematoma include the following:

  • Intra-abdominal neoplasms

  • Abdominal wall neoplasms

  • Tubo-ovarian abscess

  • Abdominal wall abscess

  • Perforations

Differential Diagnoses