Presentation
Abdominal pain in the right lower quadrant
Patient Data
Right to the midline, under the umbilical region, a hypoechoic collection in the abdominal muscle. In the center is the bladder.
Partial rupture of the rectus abdominis muscle.
An additional finding is the bilateral round-shaped fat-containing mass in the ovarian region.
Also, free abdominal fluid is detected.
Case Discussion
The patient is used to going to a fitness gym. Two days before, after getting out of bed, she started to feel pain in the right lower abdominal part. She was sent from the emergency room for an ultrasound with suspected appendicitis.
The CT confirmed the diagnosis. We found partial ruptured right-sided rectus abdominal muscle and hematoma in the rectus sheath. The hematoma and rupture can occur spontaneously in the context of anticoagulation therapy, in direct or indirect trauma, coagulopathy in cirrhosis, in degenerative vascular disease, or iatrogenic by puncture of high femoral arteries. The hematoma is considered type I because it doesn't cross the midline and does not penetrate the fascia.
Our patient didn't have cirrhosis or femoral vessel puncture and without anticoagulant therapy. We considered that the training in the gym could lead to the rupture of the abdominal muscle.
An additional finding was the bilateral dermoid cyst.