Bilateral rectus sheath hematomas
Older male patient on medical ward. Diffuse abdominal pain. Perforation?
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Bilateral 5cm rectus sheath hematomas with hemorrhagic fluid levels within. Gallstones. Marked fecal loading in the right side of the colon. No obstruction. No mass. No free fluid or gas. Atrophic pancreas.
Bilateral rectus sheath hematomas - spontaneous ones are typically secondary to warfarin therapy.
No history of warfarin therapy given at the time of the request - subsequent investigation into the clinical notes revealed patient on warfarin therapy with an elevated INR.
It is less common to observed fluid levels within the rectus sheath hematomas.