Rectus sheath hematoma has been a well-known entity from the ruin of ancient Greece3
Rectus sheath presents as acute abdomen. Females are more prone to develop rectus sheath haematoma.The presentation is a painful, tender abdominal swelling of sudden onset. This haematoma results from bleeding into the rectus sheath due to damage to the superior and the inferior epigastric arteries or their branches, or a direct tear of the rectus muscle when small branches bleed. Sometimes it can expand and lead to the hypovolemic shock and subsequent death. This haematoma usually lies posterior to the muscle. Haematomas near the umbilicus are rare. Considered causes for rectus sheath are severe exertion4,
laparoscopy and cholecystectomy7
. Berna et al, proposed that rectus sheath haematoma should be suspected in women of advancing age undergoing treatment with anticoagulants who present with triad of acute abdominal pain, infraumbilical mass and anemic syndrome8
. Other causes being coughing, thrombocytopenia and contusion9
. Ultrasound is a good investigation for diagnosis10,
showing the mass of mixed echogenicity with no internal vascularity5
. CT abdomen in particular is more useful, permits a more correct diagnosis and is considered the investigation of choice11
. Technetium -99 labeled RBC scintigraphy confirms the presence of the haematoma, site of bleeding and reveals continued bleeding6
. Selective percutaneous transcatheter arterial embolisation is considered an effective haemostatic in the treatment of a patient with a large haematoma12
. Because of the diagnostic dilemma of differentiating this condition from other acute abdominal conditions the majority of cases are treated with operative procedures3
. Non-surgical therapy is considered appropriate, but leads to a greater need for analgesics. Surgical intervention is necessary in cases with large haematomas or free intra operational ruptures10
. Early diagnosis permits conservative management even in large haematomas.
Stress is laid on clinical examination ,Carnett’s test and ultrasonography in the diagnosis of rectus sheath hematoma. A persistent pain in the lower abdomen should arouse suspicion of rectus sheath hematoma in post LSCS. Management is most of the time by conservative measures.