SPONTANEOUS RECTUS SHEATH HEMATOMA -A CASE REPORT-

Spontaneous rectus sheath hematoma, which is not derived from an external force, is rare and difficult to diagnose. The authors have recently experienced a clinical case of this disease. This is a report of the case with some comments based on the literature. The patient was a 63-year-old woman who visited our hospital because of right hypogastric pain. Physical examination indicated a tumor with pressure pain when palpated around areas slightly right of the median line and adjoining the pubic tubercle in the hypogastrium. Ultrasonography revealed a tumor in the abdominal wall, and surgery was performed under suspicion of abscess in the abdominal wall. A hematoma was found in the musculus rectus abdominis, and the right musculus rectus abdominis was separated 1/3 of the way from the lateral border. The hematoma was surgically removed under a diagnosis of rectus sheath hematoma. Women of middle or advanced age are frequent among patients with this disease. Although coughing and exercise are considered to be common inducing factors, there are many cases of unknown cause, resulting in a low rate of accurate diagnosis. The usefulness of ultrasonography has recently been recognized. However, rectus sheath hematoma is often difficult to differentiate from acute abdomen, so that this disease should be borne in mind on medical examination.