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:
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Intra-abdominal neoplasms
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Abdominal wall neoplasms
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Tubo-ovarian abscess
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Abdominal wall abscess
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Perforations
Differential Diagnoses
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Abdominal Trauma, Blunt
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Cholecystitis and Biliary Colic
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Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females
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Hernias
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Ovarian Torsion
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Rectus Sheath Hematoma. Anatomy of the rectus sheath.
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Rectus Sheath Hematoma. The Cullen sign, periumbilical ecchymosis, in a patient with a rectus sheath hematoma.
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Rectus Sheath Hematoma. Rectus sheath hematoma of the right rectus muscle. Image courtesy of Dr David Gordon.
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Rectus Sheath Hematoma. Note how the rectus sheath hematoma becomes bilobar as it dissects inferiorly (same patient as in the previous image). Image courtesy of Dr David Gordon.
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Rectus Sheath Hematoma. Ultrasound image of a rectus sheath hematoma presenting as a tender, unilateral abdominal mass. Source: Maharaj D, Ramdass M, Teelucksingh S, Perry A, Naraynsingh V. Rectus sheath haematoma: a new set of diagnostic features. Postgraduate Medical Journal. 2002;78:755-6. Reproduced with permission from the BMJ Publishing Group.
