Rectus Abdominis Hematoma: Symptoms & Treatment

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

The rectus abdominis is a muscle that forms the abdominal wall. A hematoma is a collection of blood in the body due to trauma or force. This lesson will discuss the symptoms, causes, diagnosis, and treatment of a hematoma in the rectus abdominis.

A sixty-year-old female named Diane has a history of atrial fibrillation and is on a blood thinner called Warfarin. Diane goes to see her primary care physician after she trips and falls into a chair. Her complaints are abdominal pain, a mild fever, and intermittent nausea. What could be wrong with Diane?

The Rectus Abdominis

When Diane sees her doctor, she explains her preexisting condition, medications and how she hit her abdomen on a chair after she tripped. Her doctor explained that her rectus abdominis muscle, or 'abs', starts at the pubis and runs up to meet at the fifth, sixth, and seventh ribs, and the sternum. The rectus abdominis passes through the rectus sheath which is a tendinous-muscle wrapping made by the flat tendons that connects a muscle to the parts that it moves in the body. The main function of the rectus abdominis is to move the trunk of the body, stabilize the back, and create tension to the abdominal wall. It also assists with the exhalation during breathing by contracting. Diane's doctor thinks her injury might be a hematoma in her abdominal wall.

Rectus Abdominis

Rectus Sheath

Rectus Sheath Hematoma: Symptoms and Cause

When a hematoma develops in the rectus abdominis, it is also in the rectus sheath. The occurrence of a hematoma in the abdominal wall is best known as a rectus sheath hematoma. Abdominal pain is usually the presenting problem, making this hard to diagnose, but the fact that Diane is on blood thinning medication makes it more of a possibility. Rectus sheath hematomas are not very common and occur in more women than men. Blood accumulation in the sheath of the rectus abdominis can create a hematoma in the abdomen after the rupture of an epigastric vessel or muscle tear. Symptoms include:

  • Abdominal pain
  • Fever
  • Nausea
  • Vomiting
  • Diarrhea

Diane's doctor also asks if she has been coughing, sneezing, having constipation or straining while using the bathroom, or had recent respiratory issues. All of these things can strain the rectus abdominis, which may cause a hematoma.

Additional causes of a rectus sheath hematoma include trauma to the abdominal wall, surgery, pregnancy, bleeding disorders, degenerative muscle disease, and strenuous exercise. A rectus sheath hematoma can also be spontaneous, especially if a person is on a blood thinner. In Diane's case, she is on a blood thinner and had a mild trauma to her abdomen after running into a chair.

Rectus Sheath Hematoma: Diagnosis

To confirm the doctor's initial diagnosis, Diane will have to have some blood work done. This includes:

  • Hematocrit test
  • Hemoglobin test
  • International Normalized Ratio (INR) Test

The hematocrit and hemoglobin tests measure the amount of blood that is circulating in the body. Low numbers indicate anemia. An INR blood test should also be done for people on anti-coagulants, as in Diane's case. These test results together determine the effectiveness of the blood thinning medication

Additionally she may have some diagnostic tests run, including :

  • Ultrasound
  • Abdominal CAT scan

An ultrasound will show the size, location, and physical features of the hematoma, but may also fail to detect it. A CAT scan is more successful in locating the hematoma, which also shows the size, location, and physical features of the hematoma, but can also rule out other problems.

In Diane's case, her INR was a little elevated and her hematocrit and hemoglobin were a little decreased. This could indicate a bleed in the body. A CAT scan of her abdomen was done to test for any bleeding and a small rectus sheath hematoma was found.

Rectus sheath hematoma found by CAT scan

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