A rare case report: Spontaneous rectus sheath and iliopsoas hematomas: Clinical presentation, management, and implications

Sana Landolsi; Mohamed Raouf Ben Othmane; Med Dheker Touati; Ahmed Omry; Fahd Khefacha; Faouzi Chebbi

doi:10.1016/j.ijscr.2023.108756

A rare case report: Spontaneous rectus sheath and iliopsoas hematomas: Clinical presentation, management, and implications

Int J Surg Case Rep. 2023 Sep:110:108756. doi: 10.1016/j.ijscr.2023.108756. Epub 2023 Aug 29.

Authors

Sana Landolsi¹, Mohamed Raouf Ben Othmane¹, Med Dheker Touati², Ahmed Omry¹, Fahd Khefacha¹, Faouzi Chebbi¹

Affiliations

¹ General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
² General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia. Electronic address: dhekertouati@hotmail.com.

Abstract

Introduction and importance: Frequently misdiagnosed, the clinical condition of soft tissue hematoma typically emerges following blunt abdominal trauma and/or anticoagulant medication usage, with spontaneous occurrences being infrequent. In this case report, we present a spontaneous rectus sheath and iliopsoas hematomas without obvious classical risk factors. The purpose of presenting this case is to bring attention to this unusual clinical condition and emphasize the role of thorough history and physical examination in determining the suitable course of treatment.

Case report: A 50-year-old woman with no medical history presented at the emergency room due to sudden asthenia and abdominal pain. Physical examination revealed a painful 20 cm hypogastric mass and left lumbar swelling causing leg bending. Lab tests indicated anemia and normal coagulation. CT scans showed significant hematomas in the left rectus and psoas muscles. Intensive monitoring and supportive measures stabilized her condition without resorting to surgery.

Clinical discussion: Soft tissue hematomas, notably in the rectus sheath or iliopsoas muscle, are rare but potentially severe conditions. Their pathophysiology is not fully understood, and risk factors include age, anticoagulant use, and comorbidities. Diagnosis involves abdominal examination, anemia, and CT findings. Management varies based on symptom severity and blood loss, ranging from conservative approaches to surgery or embolization.

Conclusion: Swift identification and effective handling of soft tissue hematomas hold utmost importance. The thorough history-taking and comprehensive physical examination play pivotal roles within this protocol. While supportive care constitutes the primary mode of management, instances arise where surgical intervention or vascular embolization becomes imperative for hematomas unresponsive to treatment and presenting hemodynamic instability.

Keywords: Case report; Emergency; Mesh; Rectus sheath hematomas; Spontaneous hematoma; Surgery.

Publication types

Case Reports