Ulus Travma Acil Cerrahi Derg. 2022; 28(10): 1468-1474 | DOI: 10.14744/tjtes.2022.43755

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Tolga Kalaycý¹, Murat Kartal², Mustafa Yeni^3
1Department of General Surgery, Aðrý Ýbrahim Çeçen University Faculty of Medicine, Aðrý-Türkiye
²Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum-Türkiye
³Department of General Surgery, Erzurum Regional Training and Research Hospital, Erzurum-Türkiye

BACKGROUND: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anti-coagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up.
METHODS: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups.
RESULTS: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group.
CONCLUSION: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.

Keywords: COVID-19, rectus sheath hematoma, anticoagulant therapy, morbidity, mortality.

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COVID-19 pandemisi rektus kýlýf hematomu tanýsýný ve takibini nasýl deðiþtirdi?

Tolga Kalaycý¹, Murat Kartal², Mustafa Yeni^3
1Aðrý Ýbrahim Çeçen Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Aðrý
²Atatürk Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Erzurum
³Erzurum Bölge Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Erzurum

AMAÇ: COVID-19 pandemisi nedeniyle kronik öksürük ataklarý ve antikoagülan tedavi nedeniyle rektus kýlýf hematomu (RKH) insidansýnda artýþ olmuþtur. Bu çalýþma, COVID-19 hastalarýnda RKH tanýsý öncesi ve sýrasýnda hangi parametrelerin farklýlýk gösterdiðini ve taný ve takip sýrasýnda neler beklenebileceðini belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Mart 2016 ile Mart 2021 arasýnda RKH tanýsý alan 35 hasta geriye dönük olarak deðerlendirildi. COVID-19 grubu 11 hastadan oluþuyordu. Hastalarýn geçmiþi ve taburculuk/ölüm zamaný dahil olmak üzere çeþitli bilgileri alýndý ve deney gruplarý arasýnda karþýlaþtýrýldý. BULGULAR: COVID-19’lu hastalarda, baþvuru sýrasýnda hipotansiyon oranlarý (p=0.011) ve defans ve rebound (p=0.030) oranlarý, olmayanlara göre daha yüksekti. Kanama geniþliði açýsýndan fark olmamasýna raðmen, COVID-19 hastalarýnda hemoglobin düzeylerinde (p=0.009) daha büyük bir düþüþ oldu ve o grupta eritrosit süspansiyonu ihtiyacý (p=0.040) anlamlý olarak arttý.
TARTIÞMA: Bu çalýþma, COVID-19 hastalarýnda RKH’nun ilk deðerlendirmesini oluþturmaktadýr. COVID-19 hastalarýnda yüksek hipotansiyon, defans veya rebound oranlarý ve hemoglobin seviyelerindeki düþüþler nedeniyle klinik durum ciddidir. Bu, RKH’nun klinik yönetimini daha da zorlaþtýrarak daha uzun hastanede yatýþla sonuçlanýr. Bu zorluklara raðmen, COVID-19 enfeksiyonu morbidite veya mortaliteyi artýrmaz.

Anahtar Kelimeler: Antikoagülan tedavi, COVID-19; morbidite; mortalite; rektus kýlýf hematomu.

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