Rectus sheath hematoma (RSH) involves hemorrhage within the rectus sheath. It causes abdominal pain which must be differentiated from other conditions causing abdominal pain.
Causes of hemorrhage:
(1) rupture or trauma to the rectus abdominis muscle
(2) rupture of the epigastric arteries
Risk factors:
(1) anticoagulation therapy (chronic, therapeutic, prophylactic)
(2) antiplatelet therapy
(3) immunosuppression and/or steroid therapy
(4) surgery or trauma
(5) abdominal injections or femoral puncture
(6) cough
(7) chronic kidney disease (CKD)
(8) cancer
(9) chronic liver disease
(10) other coagulopathy
(11) exercise
(12) pregnancy
(13) old age
Clinical features:
(1) abdominal pain
(2) possible mass
(3) possible ecchymosis
(4) mass on imaging studies (ultrasonography, CT, MRI)
(5) anemia with or without hypotension
If the bleed is limited and the patient is obese then few clinical signs may be seen on physical exam.
