Is conservative management of spontaneous rectus sheath hematoma effective

Objective: Spontaneous rectus sheath hematoma is a rare and often overlooked cause of acute abdominal pain. In this study, we aimed to present the results of patients with rectus sheath hematoma who received conservative treatment. Materials and Methods: In this study, the demographic data, complaints, medical history, and data pertaining to the treatment provided to 9 patients were retrospectively retrieved from the computerized patient record system and imaging archives. The included patients presented with abdominal pain to our hospital’s emergency room between January 2010 and 2016, were diagnosed with spontaneous rectus hematoma, and received conservative treatment. Results: The female/male ratio of the 9 patients who participated in this study was 1:2, and the average age was 48.8 years. All the patients were admitted to the emergency department with abdominal pain. Three patients had a history of oral anticoagulant use, 3 patients had a history of hypertension, and 1 patient had a history of chronic obstructive pulmonary disorder. No predisposing factor was detected in the other 2 patients. There was a history of severe cough in 4 patients prior to their complaints; however, there was no history of coughing, trauma, or a surgery that would lead to this condition in the other patients. Five of the 9 patients received conservative treatment as inpatient treatment for rectus hematoma, while 4 patients received it as outpatient treatment. The average duration of hospital stay of the patients was 3 days. A cerebrovascular infarction that did not cause permanent damage developed in 1 patient 2 weeks after discharge. No additional morbidity or mortality was observed in any of the other patients. Conclusion: Spontaneous rectus sheath hematoma should be considered in the differential diagnosis of abdominal pain that occurs after a persistent cough, particularly in patients receiving anticoagulant therapy. It is thought that the cases respond well to conservative treatment for etiology.