Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management
Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due t...
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doaj-1461e4338eb4447989954b96d8f6dfc02020-11-25T01:06:47ZengHindawi LimitedCase Reports in Emergency Medicine2090-648X2090-64982014-01-01201410.1155/2014/675678675678Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper ManagementGeorge Galyfos0Georgios Karantzikos1Konstantinos Palogos2Argiri Sianou3Konstantinos Filis4Nikolaos Kavouras5Department of General Surgery, General Hospital of Chalkis, 34100 Chalkis, GreeceDepartment of General Surgery, General Hospital of Chalkis, 34100 Chalkis, GreeceDepartment of General Surgery, General Hospital of Chalkis, 34100 Chalkis, GreeceDepartment of Microbiology, General Hospital of Chalkis, 34100 Chalkis, Greece1st Department of Propaedeutic Surgery, University of Athens Medical School, Ippokration Hospital, Athens, GreeceDepartment of General Surgery, General Hospital of Chalkis, 34100 Chalkis, GreeceSpontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated.http://dx.doi.org/10.1155/2014/675678 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
George Galyfos Georgios Karantzikos Konstantinos Palogos Argiri Sianou Konstantinos Filis Nikolaos Kavouras |
spellingShingle |
George Galyfos Georgios Karantzikos Konstantinos Palogos Argiri Sianou Konstantinos Filis Nikolaos Kavouras Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management Case Reports in Emergency Medicine |
author_facet |
George Galyfos Georgios Karantzikos Konstantinos Palogos Argiri Sianou Konstantinos Filis Nikolaos Kavouras |
author_sort |
George Galyfos |
title |
Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management |
title_short |
Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management |
title_full |
Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management |
title_fullStr |
Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management |
title_full_unstemmed |
Spontaneous Rectus Sheath Hematoma in the Elderly: An Unusual Case and Update on Proper Management |
title_sort |
spontaneous rectus sheath hematoma in the elderly: an unusual case and update on proper management |
publisher |
Hindawi Limited |
series |
Case Reports in Emergency Medicine |
issn |
2090-648X 2090-6498 |
publishDate |
2014-01-01 |
description |
Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient’s obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated. |
url |
http://dx.doi.org/10.1155/2014/675678 |
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