Rectus sheath hematoma due to cough attacks in an elderly patient on oral anticoagulant therapy/Oral antikoagulan kullanan yasli bir hastada oksuruk ataklarina bagli gelisen rektus kasi hematomu.
A 61-year-old woman with mitral regurgitation and atrial fibrillation was hospitalized due to palpitation palpitation (păl'pĭtā`shən), abnormal heartbeat that is often associated with a sensation of fluttering or thumping. The normal heartbeat is not noticeable to the individual. , severe cough attacks and sputum with an early diagnosis of acute bronchial infection. She was taking digoxin digoxin: see digitalis. , furosemide furosemide /fu·ro·sem·ide/ (fu-ro´se-mid) a loop diuretic used in the treatment of edema and hypertension.
A white to yellow crystalline powder used as a diuretic. , and warfarin for prevention of thromboembolic thromboembolic
pertaining to or emanating from thromboembolism.
see thromboembolic colic. events. The blood pressure was 110/80 mmHg. The heart rate was 98 beats/min and irregularly irregular. There was an apical systolic murmur on cardiac examination and there were rales and ronchi in the left lower lung area. Laboratory testing revealed the following values: glucose--145 mg/dl, hemoglobin--11.4 mg/dl, thrombocyte-224000/[mm.sup.3] and INR--2.8. A sudden, severe abdominal pain and infraumbilical solid sensitive mass developed in the patient on the third day of antibiotic treatment. The leukocyte count was normal and the hemoglobin level decreased to 9 g/dl. Ultrasound examination and computed tomography were performed with the proposal of general surgery department. A 5x5.5x9 cm hematoma in the left rectus abdominis muscle was detected in computed tomography (Fig. 1). Medical pursuit has been proposed by general surgery department. Anticoagulant treatment was stopped immediately, one unite of blood and vitamin K were given intravenously. Conservative treatment was effective and the pain has disappeared on the fifth day. A hematoma began to resorb resorb /re·sorb/ (re-sorb´) to take up or absorb again.
1. To absorb again.
2. To dissolve and assimilate such things as bone tissue. and a 4x5x9 cm organized hematoma was detected on control tomography on the seventh day (Fig. 2). An ecchymosis ECCHYMOSIS, med. jur. Blackness. It is an extravasation of blood by rupture of capillary vessels, and hence it follows contusion; but it may exist, as in cases of scurvy, and other morbid conditions, without the latter. Ryan's Med. Jur. 172. has appeared in lower abdominal area on the sixth day (Fig. 3). We thought that vigorous cough attacks in our patient with bronchitis probably caused rectus rectus /rec·tus/ (rek´tus) [L.] straight.
rectus abdominis muscle
see Table 13.2.
ocular rectus muscle
see Table 13.1F. muscle sheath hematoma in the base of oral anticoagulant drugs use. Repetitive injury during cough attacks may cause intense contraction of the rectus muscle with tearing and bleeding from the perforating branches of the inferior epigastric vessels within muscles (1). However, to develop a hematoma some specific risk factors seem to co-exist in elderly subjects; the atrophy of cutaneous and subcutaneous tissues reducing the trauma neutralization, vascular fragility or fat involution involution /in·vo·lu·tion/ (in?vo-loo´shun)
1. a rolling or turning inward.
2. a retrograde change of the body or of an organ, as the retrograde changes in size of the female genital organs after delivery. limiting the external compression during vascular leakage (2). Acute abdominal pain with evidence of abdominal mass and anemic syndrome in patients using oral anticoagulants, especially with severe cough attacks must alert physicians for diagnosis of rectus sheath hematoma (3, 4).
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(1.) Maharaj D, Ramdass M, Teelucksingh S, Perry A, Naraynsingh V. Rectus sheath hematoma: a new set of diagnostic features. Postgrad Med J 2002; 78: 290-2.
(2.) Manckoundia P, Zarouala B, Lalu-Fraisse A, Besancenot JF, Lorcerie B, Pfitzenmeyer P. Muscle hematoma in the very elderly receiving low-molecular-weight heparins (letter) Presse Med 2000; 29: 702.
(3.) Berna JD, Zuazu I, Madrigal M, Garcia-Medina V, Fernandez C, Guirado F. Conservative treatment of large rectus sheath hematoma in patients undergoing anticoagulant therapy. Abdom Imaging 2000; 25: 230-4.
(4.) Tuncer C, Sokmen G, Guven A, Koleoglu M, Oncel H, Suner A. A patient with an acute coronary syndrome acute coronary syndrome
A sudden, severe coronary event that mimics a heart attack, such as unstable angina.
acute coronary syndrome and abdominal rectus sheath haematoma Noun 1. haematoma - a localized swelling filled with blood
intumescence, intumescency - swelling up with blood or other fluids (as with congestion) mimicking acute coronary syndrome. Anadolu Kardiyol Derg 2004; 4: 372-3.
Adress for Correspondence: Ercan Varol, MD, Turan mah. 126. cad. Okur Sitesi No:22/14 32040 Isparta, Turkey
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Ercan Varol, Mehmet Ozaydin *
Department of Cardiology, Isparta State Hospital, Isparta
* Department of Cardiology, Medical Faculty, Suleyman Demirel University, Isparta, Turkey