ULTRASONOGRAPHY AND COMPUTED-TOMOGRAPHY REDUCE UNNECESSARY SURGERY INABDOMINAL RECTUS SHEATH HEMATOMA

Background Rectus sheath haematoma is a rare cause of abdominal pain. If accurately diagnosed, surgery can be avoided in most cases. This st udy assessed the role of ultrasonography and computed tomography (CT) in the diagnosis of rectus sheath haematoma. Methods Thirty cases of r ectus sheath haematoma diagnosed over 18 years were reviewed. Mean pat ient age was 59 years; there were 20 women and ten men. The results of imaging investigations were reviewed to determine their efficiency. U ltrasonography was performed in 21 patients and CT in nine. Results Ar terial hypertension, anticoagulant therapy and strained coughing were the most frequent predisposing factors. The most common clinical manif estation was abdominal pain with a palpable mass. Leucocytosis occurre d in 18 patients and the haematocrit fell in 13 patients but markedly in seven. Ultrasonography was diagnostic in 15 of 21 patients imaged, and CT was diagnostic in all nine. Treatment was conservative in 22 pa tients. Eight patients required surgery: four for diagnosis and four f or treatment. Conclusion Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis .