The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders

Background: Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Therefore, we designed a study to analyze the etiology, fre quency, diagnosis using ultrasound, and treatment of RSH. Methods: A total of 1,257 patients admitted for abdominal ultrasound for ac ute abdominal pain or unclear acute abdominal disorders were evaluated. Results: In 23 (1.8%) patients, an RSH was diagnosed; three of them were no t diagnosed preoperatively by ultrasound. Of 13 men and 10 women (mean age, 57 +/- 23 years), 13 developed RSH after local trauma, three after severe coughing, two after defecation, and five spontaneously. Fifteen had nonsurg ical therapy, and eight underwent surgery. The use of anticoagulants was ac companied by a larger diameter of the RSH (p <.012), and surgical therapy w as more frequently required in these patients. In the surgically treated gr oup, more intraabdominal free fluid could be detected by ultrasound (p <.00 05), patients required less analgesics (p <.001), and the mean hospital sta y was shorter (p<.001). Conclusions: RSH is a rare condition that is usually associated with abdomi nal trauma and/or anticoagulation therapy. Ultrasound is a good screening t echnique. Nonsurgical therapy is appropriate but leads to a greater need fo r analgesics. Surgery should be restricted to cases with a large hematoma o r free intraabdominal rupture.