Rectus Sheath Haematoma - Rare Presentation as Acute Urinary Retention

Abstract

Rectus Sheath Haematoma (RSH) is the accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It can occur spontaneously or after trauma. It is an uncommon cause of acute abdominal pain presenting to the Emergency Department and a rarer cause for acute urinary retention. To the best of our knowledge, this is the first report of RSH presenting as acute urinary retention. A 36-year-old Asian gentleman presented to the Emergency Department with complaints of acute onset urinary retention and left flank pain since one week. There was minor trauma to the abdomen two months ago, with no acute trauma. A history of prolonged bleeding from finger cut in childhood was also present. On examination there was left lower quadrant abdominal tenderness with a diffuse non-pulsatile mass in the same quadrant extending into the pelvis. Vitals were stable. Lab investigations revealed reduced haemoglobin and prolonged activated Partial Thromboplastin Time (aPTT). The prothrombin time was normal. The factor VIIIc level was markedly reduced. USG abdomen showed 280 mL of heteroechoic collection in the left anterior abdominal parietal wall, in the left rectus abdominis muscle extending to the pelvic region, compressing the urinary bladder. Computed Tomography (CT) of the abdomen and pelvis showed a RSH compressing the urinary bladder, bladder outlet and proximal urethra. Acute retention of urine was relieved immediately on catheterisation of the urinary bladder. Patient was managed conservatively with Foley’s catheter placement, and multiple transfusions of blood and factor VIII. Majority of patients with RSH can be managed conservatively. Failure to recognise RSH in patients with acute urinary retention could result in unwarranted surgical and urological interventions. In this report we emphasize the need to consider rectus sheath lesions in patients presenting with urinary retention and utility of imaging modalities such as USG or CT in quick diagnosis.

Keywords

• anticoagulation
• factor viii deficiency
• prevesical space
• space of retzius