Rectus sheath hematoma with underlying hepatic flexure hematoma secondary to stabbing

Case contributed by Heather Pascoe
Diagnosis certain


Stabbing to right upper quadrant.

Patient Data

Age: 65 years
Gender: Female


  • Large acute right rectus sheath hematoma with active bleeding.
  • Perihepatic haemoperitoenum with hematocrit level. No underlying liver laceration.
  • Large mural hematoma involving the hepatic flexure - no free gas to suggest full mural penetration; however, this cannot be excluded.
  • Pelvic free fluid of blood density.

Incidental findings:

  • Previous gastric surgery and cholecystectomy.

Case Discussion

Penetrating injuries are most often caused by firearms (see gunshot injuries) but also by knife wounds and other forms of impalement. Determining the trajectory of the wound tract assists with the evaluation of the CT as organs lying along the tract have a high likelihood of being injured.

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