Rectus sheath haematoma

Case contributed by Dr Eric F Greif

Presentation

Status post recent right leg angiogram with new onset hypotension.

Patient Data

Age: 82
Gender: Female
CT

There is moderate amount of hyperdense (Hounsfield units 50) free fluid within the right pelvis and inferior right rectus shealth representing hematoma. There is no retroperitoneal  hemorrhage. Contrast is within the distal ureters and bladder secondary to recent angiogram. 

Also noted is diverticulosis of the sigmoid colon, without evidence for diverticulitis. 

Bilateral total hip arthroplasty causing streak/beam hardening artifact, limiting evaluation of the pelvis. 

Case Discussion

Patient was status post right femoral artery catheterisation with new onset hypotension about 24 hours after procedure. Patient received 2 units of blood and an abdomen/pelvic CT was performed to rule out haemorrhage. CT demonstrated a moderate sized right pelvic and rectus sheath haematoma, likely secondary to a high right femoral artery catheterization. Notice that there is little or no hemorrhage within the right groin or thigh, a finding typically with low femoral artery catheterization complication. 

Findings are consistent with iatrogenic rectus sheath hematoma

Treatment includes conservative treatment if patient is haemodynamically stable, interventional arterial embolization, or even surgery with ligation of the bleeding vessel 1.

Our patient was treated conservatively and was taken off dopamine and remained haemodynamically stable. 

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Case information

rID: 27521
Case created: 5th Feb 2014
Last edited: 15th Mar 2016
Inclusion in quiz mode: Included

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