Hemorrhagic shock and obstructive uropathy due to a large rectus sheath hematoma in a patient on anticoagulant therapy.

Abstract

A 54-year-old woman was transferred to our hospital with disseminated intravascular coagulation, and was treated with heparin. On hospitalization day 13, she developed lower abdominal pain and mass followed by circulatory shock. She became oliguric and laboratory tests showed serum creatinine of 3.5 mg/dL and hemoglobin of 7.4 g/dL. Computed tomography showed hematoma in the left rectus sheath, compressing the urinary bladder exteriorly, which resulted in worsening of bilateral hydronephrosis. Conservative treatment resulted in resolution of the rectus sheath hematoma and improvement of renal function. Rectus sheath hematoma can be treated conservatively without surgical intervention even in complicated cases.

• Authors: Jiro Toyonaga, Kazuhiko Tsuruya, Kohsuke Masutani, Hiroto Maeda, Kuniyuki Nakamura, Masatomo Taniguchi, Hideki Hirakata, Mitsuo Iida
• Journal: Internal medicine (Tokyo, Japan) (Intern Med) Vol. 48 Issue 24 Pg. 2119-22 ( 2009) ISSN: 1349-7235 [Electronic] Japan
• PMID: 20009404 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anticoagulants
• Heparin

Topics

• Anticoagulants (administration & dosage, adverse effects)
• Drug Administration Schedule
• Female
• Hematoma (chemically induced, complications, diagnostic imaging)
• Heparin (administration & dosage, adverse effects)
• Humans
• Middle Aged
• Rectus Abdominis (pathology)
• Shock, Hemorrhagic (etiology)
• Tomography, X-Ray Computed
• Urinary Bladder Diseases (diagnostic imaging, etiology)