Clinical and radiological predictors of surgical or endovascular intervention and adverse outcomes in spontaneous rectus sheath hematoma patients.

PURPOSE: To determine clinical and radiographic parameters predictive of interventions and adverse outcomes in patients with spontaneous rectus sheath hematoma.

METHODS

This retrospective, institutional review board approved study identified 261 patients with spontaneous rectus sheath hematoma from January 2000 to August 2021 through CT report searches. Demographics, clinical presentation, comorbidities, medications, and laboratory values were collected. CT scans were reviewed for hematoma characteristics including size, location, density, and active contrast extravasation. The primary outcome was the invasive intervention; and the secondary outcomes included transfusion requirements, length of hospital stay, acute kidney injury, readmission, and mortality. Categorical variables were compared using Fisher's exact test, while continuous variables were analyzed using Student's t-test or Mann-Whitney U test as appropriate based on normality assessment.

RESULTS

The cohort comprised 261 patients (median age 71 (IQR, 60-78) years, 59% female). Invasive treatments were performed in 41 patients (15.7%): 35 underwent angiography with embolization; 6 had surgical exploration. Invasive treatment was significantly more frequent among patients with trans-umbilical extension (25.7% vs 9.4%; p < 0.001), active contrast extravasation (46.7% vs 33.0%, p < 0.001), and hematoma volume > 443.5 cc (31.8% vs 9.6%, p < 0.001)." These patients had higher red blood cell transfusion requirements (85.4% vs. 47.7%, p < 0.001) and longer hospital stays (7 vs. 4 days, p < 0.001). The overall in-hospital mortality was 6.9%, with 1.9% attributable to rectus sheath hematoma.

CONCLUSION

While most rectus sheath hematomas are managed conservatively, specific CT findings-trans-umbilical extension, larger volume, and active contrast extravasation-predict invasive intervention and guide clinical decision-making.