Rectus Sheath Hematoma: Symptoms, Causes, Treatment

What are the symptoms of a rectus sheath hematoma?

A rectus sheath hematoma occurs when blood accumulates within the rectus sheath, the connective tissue that surrounds the rectus abdominis muscles in the abdominal wall. This condition can cause a range of symptoms, which vary in severity depending on the size of the hematoma and the extent of bleeding. Common symptoms include:

Abdominal Pain: Pain is the most common symptom and can range from mild discomfort to severe, muscle cramp-like pain in the lower abdomen. The pain may be sudden and can worsen with movement or palpation.
Abdominal Tenderness: The affected area of the abdomen may be tender to touch. Palpation might reveal a firm or swollen mass due to the accumulation of blood.
Swelling or Mass: There may be noticeable swelling or a palpable mass in the abdominal wall. This swelling is often due to the accumulation of blood within the rectus sheath.
Bruising: Discoloration or bruising of the skin over the affected area may occur as blood leaks into the tissues. This might be seen as a bluish or purplish area on the skin.
Limited Range of Motion: Pain and swelling can lead to a reduced range of motion in the abdominal muscles. Activities involving the abdominal muscles may be painful or difficult.
Nausea and Vomiting: Some individuals may experience nausea or vomiting, especially if the pain is severe or if there is significant pressure on surrounding structures.
Fever: In some cases, a fever might develop, particularly if there is an associated infection or inflammation.
Hypotension and Shock: In severe cases with significant bleeding, symptoms of hypotension (low blood pressure) or shock, such as dizziness, rapid heartbeat, or fainting, might occur.

These symptoms can be similar to those of other abdominal conditions, so it’s important to seek medical evaluation for an accurate diagnosis and appropriate management.

What are the causes of a rectus sheath hematoma?

A rectus sheath hematoma is caused by bleeding into the rectus sheath, which encloses the rectus abdominis muscles. The bleeding can occur due to various factors, including:

Trauma or Injury: Direct trauma to the abdominal wall, such as from a fall, car accident, or sports injury, can rupture blood vessels in the rectus sheath, leading to a hematoma.
Abdominal Surgery: Surgical procedures involving the abdomen, particularly those involving the rectus muscles or surrounding tissues, can damage blood vessels and cause a hematoma. This includes surgeries like hernia repairs or cesarean sections.
Strenuous Physical Activity: Intense or repetitive physical activity, especially activities that involve heavy lifting or excessive straining, can strain the abdominal muscles and blood vessels, potentially leading to a hematoma.
Anticoagulant Therapy: Use of anticoagulant medications, such as warfarin or heparin, increases the risk of bleeding. Patients on these medications may develop a rectus sheath hematoma more easily, even with minor trauma or strain.
Pregnancy and Postpartum Period: Pregnancy, particularly with multiple pregnancies or after cesarean section, can increase the risk of rectus sheath hematoma due to stretching and increased pressure on the abdominal muscles and blood vessels.
Spontaneous Bleeding: In rare cases, a rectus sheath hematoma can occur spontaneously without a clear cause, often in patients with underlying conditions that predispose them to bleeding.
Coagulation Disorders: Patients with underlying bleeding disorders or conditions that affect blood clotting may be at increased risk of developing a hematoma.
Abdominal Coughing or Vomiting: Severe or persistent coughing or vomiting can increase intra-abdominal pressure and potentially lead to the rupture of blood vessels in the rectus sheath.
Tumors or Masses: In rare cases, tumors or other masses in the abdominal wall can erode or disrupt blood vessels, leading to a hematoma.

Identifying the cause is important for appropriate management and to address any underlying issues that may contribute to the development of a rectus sheath hematoma.

What is the treatment for a rectus sheath hematoma?

Treatment for a rectus sheath hematoma focuses on managing symptoms, promoting healing, and addressing any underlying causes. The approach depends on the size of the hematoma, the severity of symptoms, and whether there are any complications. Here are the common treatment strategies:

Conservative Management

Rest and Activity Modification: Resting and avoiding activities that could worsen the condition, such as heavy lifting or strenuous exercise, can help prevent further bleeding and promote healing.
Pain Management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help manage pain and reduce inflammation. In some cases, stronger pain medication may be prescribed if needed.
Ice Application: Applying ice to the affected area can help reduce swelling and discomfort in the initial stages following the injury or onset of symptoms.
Compression: In some cases, applying a compression bandage may help control swelling, but it should be done with caution to avoid increasing abdominal pressure.
Monitoring: Regular monitoring of the hematoma’s size and the patient’s symptoms is important. Follow-up with a healthcare provider helps ensure that the hematoma is not growing and that there are no complications.

Medical Management

Observation: Small hematomas that are not causing significant symptoms may only require observation. Medical professionals will monitor the condition through physical exams and possibly imaging studies.
Blood Tests: Blood tests may be conducted to assess blood counts and monitor for any potential bleeding complications or underlying coagulation issues.
Management of Coagulopathy: If the patient is on anticoagulant therapy or has a bleeding disorder, adjustments to medication or specific treatments to manage the coagulopathy may be necessary.

Surgical Intervention

Surgical Drainage: In cases where the hematoma is large, causes significant symptoms, or is not resolving with conservative measures, surgical drainage may be required. This involves making an incision to remove the accumulated blood and relieve pressure.
Repair of Associated Injuries: If the hematoma resulted from trauma or surgery, additional procedures may be necessary to address the underlying injury or repair damaged tissues.

Follow-Up and Rehabilitation

Physical Therapy: Once the acute phase has resolved, physical therapy may be recommended to restore strength and function to the abdominal muscles and prevent future issues.
Gradual Return to Activity: Gradually resuming normal activities and avoiding high-impact exercises until the hematoma has fully healed is important for preventing recurrence.

Considerations

Monitoring for Complications: In rare cases, complications such as infection or significant blood loss may occur. Prompt medical attention is necessary if symptoms of these complications arise.

The specific treatment plan should be tailored to the individual’s condition, taking into account the size of the hematoma, the severity of symptoms, and any underlying health issues. Consulting with a healthcare provider is crucial for determining the most appropriate treatment approach.