Abstract
We report herein a case of a 58‐year‐old woman with COVID‐19. During the hospitalization, the patient complained of acute abdominal pain, and abdominal CT revealed the rectus sheath hematoma (RSH). Since corticosteroids and anti‐coagulation are commonly administered in COVID‐19 patients, physicians should consider RSH as a possible diagnosis for acute abdominal pain.
Keywords: abdominal pain, coronavirus disease 2019, COVID‐19, rectus sheath hematoma
Rectus Sheath Hematoma though infrequent should be considered as a possible cause of acute abdominal pain in COVID‐19 patients.
1. CASE DESCRIPTION
A 58‐year‐old obese woman was admitted to our hospital complaining of cough and sore throat with an unremarkable past medical history and no history of trivial trauma. She was tested positive for COVID‐19, and she was receiving corticosteroids and anti‐coagulation (Heparin 5000 unit/SC/TDS) along with remdesivir. On the third day of hospitalization, the patient developed abdominal pain, and the abdominal CT confirmed left rectus sheath hematoma (RSH) (Figure 1). Due to the rapid hematoma expansion (over four cm of expansion in 4 h) and unstable hemodynamics (tachycardia and hypotension), she was treated with immediate angioembolization of the inferior epigastric artery. The patient was discharged 6 days later in good condition, and she was completely free of symptoms during the 3 months of follow‐up.
FIGURE 1.
Abdominal (left) and lung (right) CT of the patient. The RSH is shown with an arrow
Rectus sheath hematoma mostly happens in the setting of blunt abdominal trauma or anti‐coagulation therapy. In addition, various predisposing factors such as hypertension, obesity, and corticosteroid administration have been identified in association with RSH. 1 Furthermore, corticosteroids and anti‐coagulation are commonly administered in COVID‐19 patients. 2 Also, coughing in COVID‐19 patients may exert intense muscle contraction, leading to RSH. In this regard, although abdominal pain may be experienced during the COVID‐19 disease, physicians should consider RSH as a possible diagnosis in suspected patients.
CONFLICTS OF INTEREST
The authors declare that there is no conflict of interest.
AUTHOR CONTRIBUTION
AJ, HRN, and FH conceptualized the data. AJ, JJ, and HRN curated the data. FH and HRN wrote the original draft. AJ and JJ edited the draft.
ETHICAL APPROVAL
Written informed consent was obtained from the patients prior to the publication.
CONSENT
Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.
ACKNOWLEDGEMENTS
None.
Javidi A, Niazkar HR, Jalili J, Homapour F. Rectus sheath hematoma in COVID‐19 patient: The importance of abdominal pain in the course of COVID‐19. Clin Case Rep. 2022;10:e05768. doi: 10.1002/ccr3.5768
Funding information
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DATA AVAILABILITY STATEMENT
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REFERENCES
- 1. Hatjipetrou A, Anyfantakis D, Kastanakis M. Rectus sheath hematoma: a review of the literature. Int J Surg. 2015;13:267‐271. [DOI] [PubMed] [Google Scholar]
- 2. Coppock D, Baram M, Chang AM, et al. COVID‐19 treatment combinations and associations with mortality in a large multi‐site healthcare system. PLoS One. 2021;16(6):e0252591. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
None.