| 摘要 |
Rectus sheath hematoma (RSH) is an uncommon but sometimes life-threatening illness. It can occur spontaneously. Secondary to trauma, invasive procedure or coagulopathies. Treatments may be delayed due to unnecessary diagnostic procedures or unwanted surgery. Increased morbidity and even mortality may be the result. We described two cases of RSH. Patient 1: A 57 y/o woman presented with sudden onset of RLQ abdominal pain. Vital signs on arrival were respiration 16 breaths per minute, pulse 86 beats per minute, blood pressure 134/84 mmHg and temperature 37.0℃. Significant RLQ abdominal tenderness was found. Laboratory results were WBC 8,120/mm3, Hb 13.1 g/dl, Hct 37%, platelet 203,000/mm3, AST/ALT 46/59 IU/L, BUN/Cre 13.0/0.9 mg/dl, and glucose 157 mg/dl. Electrolytes and cardiac markers were unremarkable. Abdomen CT revealed extensive enlargement of the right rectus abdominis muscle with extravasation of contrast medium. Surgical operation was undertaken for intractable pain. Patient 2: A 61 y/o woman presented because she crushed her abdomen against the handlebar during a motor vehicle accident. Vital signs on arrival were respiration 20 breaths per minute, pulse 70 beats per minute, blood pressure 143/87 mmHg, and temperature 36.5℃. A soft mass was palpable on her right abdomen with ecchymosis. Laboratory results were WBC 11,130/mm3, Hb 12.5 g/dl. Hct 36.4%, plat 195,000/mm3; PT 9.8”(9.8”), aPTT 26.8”(37.5”), AST/ALT 44/43 IU/L, BUN/Cre 12.4/0.8 mg/dl, glucose 156 mg/dl, Na+/K+ 133/3.66 mEq/L and unremarkable cardiac markers. Abdomen CT revealed a soft-tissue density infiltration over the right anterior abdominal wall with extravasation of contrast medium. She was admitted to the surgical ward and an operation was undertaken on the following day because of progressive hemorrhage. They had uneventful recoveries after surgical operations. Although uncommon, both the emergency physician and the surgeon should be familiar with this disease because the incidence will increase, as elderly patients, anticoagulation therapy and invasive procedures become more commonplace. |
