Khan Mohammad Imran, Medhat Osman, Popescu Octavian, Rastogi Amit, Thompson Tom
Department of Medicine and Radiology, Wanganui Hospital, Wanganui, New Zealand.
N Z Med J. 2005 Jun 24;118(1217):U1523.
Rectus sheath haematoma (RSH) is a rare cause of acute abdomen. We present a case series of patients seen at Wanganui Hospital, North Island, New Zealand.
A retrospective survey of patients developing RSH over a 2-year period (from 2002 to 2004) in our hospital was carried out.
Seven patients were identified with RSH (male:female ratio=6:1, age range=16-80 years). Six of the RSH were spontaneous and four out of these six were on anticoagulant therapy post-acute coronary event. Each presented with acute abdomen and all were missed on initial evaluation. Two were diagnosed initially as bowel obstruction, one as acute diverticulitis, one as incarcerated hernia, one as an ovarian mass, and another as non-specific abdominal pain. One patient had traumatic RSH with peritonitis secondary to accompanying jejunal perforation. The ultrasound pick-up rate was 50% of but computed tomography (CT) abdomen was 100% diagnostic. Five (70%) had a significant fall in haematocrit, requiring blood transfusion. All settled on conservative management, with one requiring admission to intensive care.
Clinical diagnosis of RSH is unreliable. CT imaging is the procedure of choice and should be promptly carried out especially in those on anticoagulant therapy for early diagnosis and proper management.
腹直肌鞘血肿（RSH）是急腹症的一种罕见病因。我们报告一组在新西兰北岛旺阿努伊医院就诊的病例。
对我院2002年至2004年两年间发生RSH的患者进行回顾性调查。
确诊7例RSH患者（男:女比例为6:1，年龄范围16 - 80岁）。其中6例为自发性RSH，这6例中有4例在急性冠脉事件后接受抗凝治疗。所有患者均表现为急腹症，初诊时均被漏诊。2例最初诊断为肠梗阻，1例为急性憩室炎，1例为嵌顿疝，1例为卵巢肿物，另1例为非特异性腹痛。1例患者为创伤性RSH并伴有空肠穿孔继发腹膜炎。超声检出率为50%，但腹部计算机断层扫描（CT）诊断率为100%。5例（70%）血细胞比容显著下降，需要输血。所有患者经保守治疗均康复，1例需入住重症监护病房。
RSH的临床诊断不可靠。CT成像为首选检查方法，尤其对于接受抗凝治疗的患者应及时进行CT检查，以便早期诊断和正确治疗。
