Understanding Rectus Sheath Hematoma: Causes and Treatment

Rectus sheath hematoma (RSH) is an uncommon but clinically significant condition that arises when blood accumulates within the rectus sheath, the fibrous compartment housing the rectus abdominis muscles.

This condition can often be confused with other abdominal pathologies, making accurate diagnosis vital for effective management.

Causes and Pathophysiology of Rectus Sheath Hematoma

Causes of Rectus Sheath Hematoma

Rectus sheath hematoma can be induced by a variety of factors that disrupt the integrity of the epigastric vessels, which supply blood to the rectus abdominis muscles. Common causes include:

Trauma-related Hematoma: Direct trauma to the abdominal wall, such as from a fall, blunt impact, or surgical procedures, can lead to vessel rupture and hematoma formation.
Strain-related Injury: Activities that increase intra-abdominal pressure, such as heavy lifting or severe coughing, can cause strain-related injuries to the rectus sheath, resulting in hematoma.
Anticoagulation Therapy: Patients on anticoagulant or antiplatelet medications are at an increased risk due to impaired hemostasis, leading to spontaneous haemorrhage.

Pathophysiology of Rectus Sheath Hematoma

The pathophysiology of RSH involves the rupture of the superior or inferior epigastric arteries within the rectus sheath, causing blood to accumulate. Depending on the location of the rupture, hematomas may be classified into three types:

Type I: Small, confined hematomas that do not cross the midline or extend beyond the rectus sheath.
Type II: Larger hematomas that may cross the midline but remain confined within the rectus sheath.
Type III: Massive hematomas that extend into the peritoneal cavity, posing significant clinical challenges.

Risk Factors and Symptoms

Risk Factors for Rectus Sheath Hematoma

Several risk factors predispose individuals to the development of rectus sheath hematoma:

Age: Older adults are more susceptible due to frail vasculature and increased likelihood of anticoagulant use.
Gender: Females, particularly those who are pregnant, may be at higher risk due to physiological changes and increased abdominal pressure.
Coagulation Disorders: Conditions affecting blood clotting can lead to spontaneous hematoma formation.

Symptoms of Rectus Sheath Hematoma

Symptoms of rectus sheath hematoma can vary depending on the size and location of the hematoma:

Localized Pain: Patients often experience acute, sharp pain localized to the abdomen, exacerbated by movement or palpation.
Palpable Mass: A firm, tender mass may be palpable in the abdominal wall.
Ecchymosis: Bruising may be visible over the affected area, particularly in cases of extensive hematoma.

Get a second opinion from trusted experts and makeconfident, informed decisions.

Get Second Opinion

Your health is everything - prioritize your well-being today.

Schedule Your Appointment

Diagnosis and ICD-10 Classification

Diagnosis of Rectus Sheath Hematoma

Accurate diagnosis of rectus sheath hematoma requires a combination of clinical evaluation and imaging studies:

Physical Examination: Detailed history and physical examination can help differentiate RSH from other abdominal conditions.
Ultrasonography: A non-invasive imaging modality that can detect fluid collections and assess hematoma size.
CT Scan: Computed tomography provides a detailed view of the hematoma and its extent, aiding in classification and management decisions.

Rectus Sheath Hematoma ICD-10 Code

In the International Classification of Diseases, Tenth Revision (ICD-10), rectus sheath hematoma is classified under the code S30.1, which denotes "Contusion of abdominal wall."

Treatment and Management

Treatment Options for Rectus Sheath Hematoma

The management of rectus sheath hematoma is guided by the severity of symptoms and the type of hematoma:

Conservative Management: In cases of small, uncomplicated hematomas, conservative measures such as rest, analgesia, and cessation of anticoagulant therapy may suffice.
Interventional Radiology: For larger hematomas or those with active bleeding, interventional radiology techniques such as embolization may be employed to control hemorrhage.
Surgical Intervention: Rarely, surgical evacuation may be necessary for massive hematomas that do not respond to conservative or interventional measures.

Complications Associated with Rectus Sheath Hematoma

While many rectus sheath hematomas resolve without significant sequelae, complications can arise, particularly with type III hematomas:

Hemodynamic Instability: Massive bleeding can lead to shock, necessitating urgent resuscitation.
Infection: Hematomas may become infected, requiring antibiotic therapy or drainage.
Chronic Pain or Disability: Persistent pain or functional impairment may occur if the hematoma is not adequately managed.

Find Our Specialists

Book Doctor Appointment