Ematoma spontaneo del muscolo retto addominale: evenienza rara, diagnosi difficile e trattamento multidisciplinare. Presentazione di 5 casi clinici e revisione della letteratura

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Ciro De Martino

Abstract

Spontaneous rectus sheath hematoma is a rare condition. It encompasses a wide spectrum of severity (self-limiting to fatal) depending of its size, etiology, and the development of complications. It enters into the differential diagnosis of abdominal pain but it’s frequently difficult to diagnose and often radiologic imaging is required.


Authors report a series of five patients admitted at emergency room within a 2-year period. Patient were between 63 to 78 years old. One of them was in therapy with warfarin, one was in therapy with acetilsalicililate and clopidogrel and in an another patient a coagulation disorder was detected. Diagnosis was suspected in all cases by clinical exam and ultrasonography, but CT-scan was necessary in three cases. All patients underwent conservative treatment, mainly pain relief and rest. In two cases blood transfusion was performed and in two cases clotting abnormalities were corrected with vitamin K and fresh frozen plasma.


Average ospedalization was 10 days (range 5-17). One patient developed late seroma and was treated with ultrasoundguided aspiration.


Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. The difficulties in the correct diagnosis frequently lead to delay in treatment or unneeded surgery. CT-scan is the gold-standard investigation. Treatment options are variable and include conservative treatment, intravascular embolization and surgery.


Frequently an interdisciplinary team approach is needed

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How to Cite
Ciro De Martino. “Ematoma Spontaneo Del Muscolo Retto Addominale: Evenienza Rara, Diagnosi Difficile E Trattamento Multidisciplinare. Presentazione Di 5 Casi Clinici E Revisione Della Letteratura”. Annali Italiani Di Chirurgia, vol. 83, no. 5, Sept. 2012, pp. 399-04, https://annaliitalianidichirurgia.it/index.php/aic/article/view/3033.
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