Spontaneous Rectus Sheath Hematoma as a Rare Cause of Abdominal Pain in a Patient Under Oral Anticoagulation

Rectus sheath hematoma (RSH) is a rare entity [1] which is caused by rupture of the perforating branches of the inferior epigastric artery running in the preperitoneal fat, causing a large haematoma spreading in the looser rectus sheath space. Non-invasive imaging modalities including CT scan are the key to establish its early diagnosis. It is often misdiagnosed as many other serious intra-abdominal diseases, such as appendicitis, diverticulitis, cholecystitis, incarcerated inguinal hernia, torsion of an ovarian cyst or acute pancreatitis [2]. RSH is usually seen in patients with coagulation disorders and other predisposing causes including abdominal trauma, previous surgery, asthma, stretching, hypertension, pregnancy, intraabdominal injection, and iatrogenic causation during laparoscopy. Patients with rectus sheath hematoma usually present with severe abdominal pain and abdominal wall mass. Our patient who received warfarin therapy for 18 years due to atrial fibrillation presented to our emergency department with abdominal pain.