A Case of Rectus Sheath Hematoma Due to Anticoagulants after Total Knee Arthroplasty

Background: Hematoma in the rectus sheath is not common but if happens it will become major bleeding. Sometimes anticoaglation of deep vein thrombosis (DVT) causes the hematoma in the rectus sheath. Case Report: A 74-year-old female patient after total knee arthroplasty (TKA) due to osteoarthritis. Postoperation, residual DVT was noted in the right soleus vein on ultrasonography of the veins of the lower limbs. Anticoaglation was started 7.5 mg/day Arixtra for treatment of DVT. Anticoaglation was administered throughout rehabilitation, and abdominal pain developed on postoperative day 9. Since respiratory distress developed on day 10, then thoracoabdominal contrast CT was performed. Although no PE was observed, a hematoma was detected in the rectus sheath, and it perforated into the abdominal cavity. The hemoglobin level was reduced by about 4 g/dL, and the patient was admitted to the ICU. Surgical treatment was not performed, anticoagulant treatment was discontinued, and conservative treatment was administered. During management in the ICU, a total of 24 units of red blood cells were transfused. Conclusions: Rectus sheath hematoma should be in mind of surgeons during differential diagnosis of acute abdominal pain especially in patients receiving anticoagulants. Early recognition can be of great importance for patients’ recovery, preventing from severe complications. Management is usually supportive although surgical intervention in some patients should be considered.