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Case Reports in Emergency Medicine
Volume 2014, Article ID 675678, 4 pages
http://dx.doi.org/10.1155/2014/675678
Case Report

Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management

1Department of General Surgery, General Hospital of Chalkis, 34100 Chalkis, Greece
2Department of Microbiology, General Hospital of Chalkis, 34100 Chalkis, Greece
31st Department of Propaedeutic Surgery, University of Athens Medical School, Ippokration Hospital, Athens, Greece

Received 26 January 2014; Accepted 16 February 2014; Published 11 March 2014

Academic Editors: K. Imanaka and M. A. Memon

Copyright © 2014 George Galyfos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated.