Rectus sheath hematoma is a not uncommon condition caused by iatrogenic injury during laparoscopic injury or seen in the setting of anticoagulation, especially in an older patient. The bleeding has been described as both venous and arterial in origin.
Rectus sheath hematoma (arrow)
Rectus sheath hematoma symptoms can mimic intra-abdominal pathology. Abdominal pain and tenderness (worsened with abdominal wall contraction) is almost always the initial complaint and finding and CT scan facilitates correct diagnosis.
The most typical location of rectus sheath hematoma is in the lower abdomen, below the semicircular line. Here the epigastric vessels are separated from the rectus muscle fibers only by a thin sheath of fascia and preperitoneal fat.
Generally, the treatment is conservative and those with a stable hematoma are treated by pain medication and avoidance of abdominal wall stress.
In an expanding hematoma, the lesion must be controlled surgically and the epigastric vessels are ligated both above and below the hematoma with evacuation of the blood
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