An Uncommon Presentation of Spontaneous Rectus Sheath Hematoma with Acute Kidney Injury due to Obstructive Uropathy and Prerenal Azotemia
Table 2
Berna and Osinbowale RSH classification. Computed tomography severity grades and suggested management strategy, modified and reprinted with permission from Osinbowale and Bartholomew [13].
Grade
Anatomic extension
Symptoms
Management
I
Intramuscular, unilateral; does not dissect along fascial planes.
Mild to moderate pain. No drop in hemoglobin.
Conservative; usually outpatient follow-up only.
II
Bilateral; some dissection between the muscle and transversalis fascia; no extension into the prevesical space.
Minor drop in hemoglobin.
Observation, short hospital stay. May need transfusion.
III
Bilateral, large; dissects between the transversalis fascia and muscle into the peritoneum and prevesical space.
Significant drop in hemoglobin and hemodynamic instability.
Reversal of anticoagulants and blood transfusion. Angiographic interventions may be needed.
