Ulus Travma Acil Cerrahi Derg. 2007; 13(1): 55-59

Tretament approaches to rectus sheat hematoma

Kaðan Zengin, Sinan Çarkman, Ýlknur Kýlýç, Evrim Beken, Erhun Eyüboðlu
Istanbul University, Cerrahpasa Medical Faculty, General Surgery Emergency Medicine Unit

BACKGROUND
Rectus sheath hematoma (RSH) is one of the rare causes of acute abdominal pain. This clinical entity is frequently misdiagnosed and leads to unnecessary surgical intervention. We investigated the critical points of the diagnosis and therapy in preventing these mistakes.
METHODS
Five patients (5 females; mean age 67.4; range 53 to 74 years) admitted to the emergency surgery unit and diagnosed as RSH between December 2000 and July 2005 were reviewed retrospectively. Demographic characteristics, medical history complaints and physical examination, laboratory and imaging studies findings were investigated.
RESULTS
Four patients had been receiving anticoagulant therapy. All of the cases were complaining of abdominal mass and abdominal pain. In the physical examination painful mass was palpated. In cases anemia determined, the diagnosis was done only by computed tomography (CT) in one case, by ultrasonography (USG) and CT in three cases, and during surgical exploration for acute abdomen in one case. Blood transfusion was administered in all of the cases. In four patients anticoagulant therapies were discontinued and intravenous vitamin K and fresh frozen plasma were administered. In one case bleeding control was done during the operation. While three cases were discharged uneventfully following mean hospital stay of 13.6 days, two cases died on the fifth and seventh days.
CONCLUSION
In elderly patients with acute abdominal pain, infraumblical mass, anemia and history of anticoagulation therapy, RSH should be taken into consideration and USG and CT should be performed. Early and accurate diagnosis helps for a successful medical treatment and prevents unnecessary surgical intervention.

Keywords: Anticoagulant/adverse effects/therapeutic use, hematoma/diagnosis/therapy; rectus abdominis/radiography/ultrasonography; vitamin K.

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Rektus kýlýf hematomu olgularýna yaklaþýmýmýz

Kaðan Zengin, Sinan Çarkman, Ýlknur Kýlýç, Evrim Beken, Erhun Eyüboðlu
Ýstanbul Üniversitesi, Cerrahpaþa Týp Fakültesi, Genel Cerrahi Acil Týp Birimi.

AMAÇ
Rektus kýlýf hematomu (RKH) akut karýn aðrýsýnýn nadir görülen nedenlerinden birisidir. Sýklýkla gözden kaçar ve gereksiz cerrahi giriþimlere neden olur. Bunun önlenmesi amacýyla taný ve tedavide dikkat edilmesi gerekli noktalar incelendi.
GEREÇ VE YÖNTEM
Aralýk 2000-Temmuz 2005 yýllarý arasýnda acil cerrahi polikliniðinde RKH tanýsý alan beþ hasta (5 kadýn; ort. yaþ 67,4; daðýlým 53-74 yaþ) retrospektif olarak incelendi. Olgularýn demografik özellikleri, özgeçmiþleri ve yakýnmalarý, tanýya götüren fiziksel inceleme, laboratuvar ve görüntüleme yöntemlerindeki bulgular ve tedavi yöntemleri araþtýrýldý.
BULGULAR
Tüm olgularýn yakýnmasý karýnda kitle ve karýn aðrýsý idi. Dört olgu antikoagülan tedavisi almaktaydý. Fiziksel incelemede palpabl aðrýlý kitle bulundu. Anemi saptanan olgularda taný, birinde yalnýzca bilgisayarlý tomografi (BT), üçünde ultrasonografi (USG) ve BT yardýmýyla ve bir olgudaysa akut karýn düþünülerek yapýlan cerrahi eksplorasyon sýrasýnda konuldu. Tedavi olarak olgularýn tümünde tam kan ve dört olguda antikoagülan tedavisi kesilip, K vitamini ve taze donmuþ plazma verildi. Bir olguda kanama kontrolü ameliyat sýrasýnda yapýldý. Hastalarýn üçü ortalama 13,6 gün yatýþ süresi sonrasý þifa ile taburcu edilirken, iki olgu ameliyat sonrasý iki olgu beþinci ve yedinci günlerde kaybedildi.
SONUÇ
Akut karýn aðrýsý, göbek altý kitlesi ve anemisi olup antikoagülan kullanan ileri yaþlý hastalarda RKH’den þüphe edilmelidir. Klinik þüphe halinde USG veya BT yapýlmalýdýr. Erken ve doðru taný konservatif tedavinin baþarýlý olmasýný ve gereksiz cerrahi giriþimi önler.

Anahtar Kelimeler: Antikoagülan/yan etki/terapötik kullaným, hematom/taný/tedavi; rektus abdominis/radyografi/ultrasonografi; K vitamini.

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