Rectus sheath hematoma (post-operative)

Case contributed by Dr Kewal Arunkumar Mistry


Increasing abdominal swelling and pain on 2nd post-operative day of an elective cesarean section.

Patient Data

Age: 29 years
Gender: Female

Ultrasound of the abdomen shows a large mixed echogenic area in the intramuscular planes of anterior abdominal wall muscles suggestive of hematoma.

Uterus is of postpartum size.

Dilated gut loops and hemoperitoneum are also present.

CT shows intramuscular anterior abdominal wall hematoma on left side with postpartum size uterus, air foci within abdominal wall (postoperative), dilated bowel loops suggestive of postoperative paralytic ileus and high density ascites suggestive of hemoperitoneum. Also note mild left pleural effusion.

Case Discussion

Based on history and imaging, diagnosis of rectus sheath hematoma with paralytic ileus and hemoperitoneum was made.

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Case information

rID: 34778
Published: 8th Mar 2015
Last edited: 4th Jan 2020
Inclusion in quiz mode: Included