Rectus sheath hematoma occured in a case receiving hemodialytic therapy *
Hemorrhage within the sheath of the rectus abdominis muscle is an uncommon cause of abdominal pain. The usual etiology is secondary to minor trauma in a patient who is received anticoagulants. Here we present a case of a rectus sheath hematoma occurred in patient during hemodialytic therapy using an anticoagulant drug (heparin), which was correctly diagnosed by computed axillary tomography (CT) of the abdomen. A 75-year-old woman was admitted to our hospital with renal failure due to polyarteritis nodosa. On the fourth day after admission, she was treated with hemodialysis using heparin and then became aware of a very tender mass in the right lower quadrant (RLQ) of abdomen. Ultrasonography and CT revealed a large mass localized in the right rectus sheath in the RLQ consistent with a spontaneous rectus sheath hematoma. She immediately received conservative therapy including discontinuation of heparin and a change to hemodialysis using nafamostat mesilate. Her pain and abdominal mass were slowly resolved. We have collected 84 cases of rectus sheath hematoma from the Japanese literature. Among them, only three cases have been reported as a complication of hemodialytic therapy. Recognition of the factors predisposing a patient to such a hematoma among patients receiving hemodialytic therapy is essential. (Accepted on August 17. 1998) Kawasaki Igakkaishi 24(2) : 113 - 118. 1998
