%0 Journal Article
%T Rectus Sheath Hematoma¡ªA Rare and Dangerous Complication of Anticoagulation Therapy<br/>¡ªA Case Report and Review of Current Literature
%A Tobias Hoefflinghaus
%A Lea Landolt
%A Esther B. Bachli
%J Open Journal of Internal Medicine
%P 87-94
%@ 2162-5980
%D 2014
%I Scientific Research Publishing
%R 10.4236/ojim.2014.43014
%X Rectus sheath hematoma (RSH) is a rare bleeding site which can be life-threatening. Our aim was to analyze clinical features, diagnosis, treatment and outcome of these cases in a general hospital. Results: During a period of 24 months, 8 cases of RSH were diagnosed (0.1% of all inpatients). Mean age was 79.4 years (y, SD <span style=\"font-family:Verdana, Helvetica, Arial;line-height:18px;white-space:normal;background-color:#FFFFFF;\">+</span>/<span style=\"font-family:'Verdana, Helvetica, Arial';\"><span style=\"line-height:18px;\">-</span></span> 14.1). 75% were female. 7 patients (pts) were on therapy with oral anticoagulants (OAC), 2 had a history of additional therapy with aspirin (ASA), 4 had low molecular weight heparin (LMWH) for bridging of OAC therapy. 4 pts had INR values between 3.1 - 4.4. One pt with liver cirrhosis (Child A), mild thrombocytopenia had ASA and LMWH prophylactically. Five pts (63%) were coughing. Main symptom was localized pain in 7 pts. One pt was incidentally diagnosed on a CT scan performed for different reason. 7 pts had a palpable mass of the abdominal wall. 5 RSH were diagnosed with CT, 2 with ultrasound, 1 clinically. All pts were treated conservatively. In 7 pts vitamine K and Beriplex<span style=\"font-family:'Verdana, Helvetica, Arial';font-size:xx-small;\"><span style=\"line-height:18px;\">&lt;sup&gt;<span style=\"font-family:Verdana, Helvetica, Arial;line-height:18px;white-space:normal;background-color:#FFFFFF;\">&amp;#174&lt;/sup&gt;</span></span></span>&nbsp;was substituted to reverse OAC. 4 pts received blood transfusions (1 - 4 units). The mean change of hemoglobin (Hb) was 37 g/l (SD <span style=\"font-family:Verdana, Helvetica, Arial;line-height:18px;white-space:normal;background-color:#FFFFFF;\">+</span>/<span style=\"font-family:'Verdana, Helvetica, Arial';\"><span style=\"line-height:18px;\">-</span></span> 22 g/l). The renal function was impaired in 7 pts (mean creatinine clearance 51 ml/min <span style=\"font-family:Verdana, Helvetica, Arial;line-height:18px;white-space:normal;background-color:#FFFFFF;\">+</span>/<span style=\"font-family:'Verdana, Helvetica, Arial';\"><span style=\"line-height:18px;\">-</span></span> 12.4) and declined further. 3 out of 8 pts died (38%, age 90 - 92 y, all female). In these patients, the observed change in Hb was 42 - 58 g/l. 2 pts had combination of VKA and LMWH. 1 pt had VKA only. Conclusion: Acute abdominal pain in pts with any form of OAC or therapy to inhibit platelet function should always raise suspicion about RSH. Extensive blood loss, shock and aggravation of
%K Rectus Sheath Hematoma
%K Anticoagulation
%K Complication
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=49818