Rectus sheath hematoma: diagnosis by computed tomography scanning.

A 65-year-old woman receiving long-term oral anticoagulant therapy was admitted with signs and symptoms suggesting colonic obstruction. A tender, firm left lower-quadrant mass, colonic and small bowel distention, mild leukocytosis, and a markedly elevated prothrombin time were the prominent presenting abnormalities. Emergency colon x-ray study did not demonstrate colonic obstruction, and ultrasound of the abdomen was initially nondiagnostic. Computed tomography scanning revealed a large mass localized in the left rectus sheath and muscle consistent, in this clinical setting, with a spontaneous rectus sheath hematoma. The purpose of this report is to suggest the usefulness of computed tomography scanning in the evaluation of indeterminate abdominal masses such as the rectus sheath hematoma. The subject of rectus sheath hematoma is reviewed to emphasize its inclusion in the differential diagnosis of the acute abdomen and to suggest an earlier, more accurate, and noninvasive approach to its diagnosis.