Rectus sheath hematoma established as a sarcoma: a case study

Abstract

Abdominal wall hematoma is due to bleeding into the muscle layers of the abdominal wall, the most common among the abdominal hematomas are rectus sheath hematomas. Rectus sheath hematoma is a rare pathology that occurs due to damage to either the superior or inferior epigastric vessels or damage to small vessels due to the disruption of the rectus muscle itself. Patients with rectus sheath hematoma typically present with nonspecific symptoms, such as abdominal pain, making it challenging to diagnose solely based on clinical presentation. Imaging technology such as USG and CT are required for further confirmation. However, for chronic cases of rectus sheath hematoma, USG and CT can be inconclusive and further diagnostics with MRI or diagnostic laparoscopy is required. We described a case of a 42-years-old female, who came to the oncological surgical department of Grodno University Clinic with complaints of abdominal pain for 1 month. The USG and CT showed signs of malignancy, a suspicious formation arising from the muscles and recommendations of further testing for visceral organ involvement since USG suggested intestinal involvement and CT could not rule out growth into the peritoneum. Endoscopically biopsy and cytological examination was done to confirm presence of malignancy and came out negative. Diagnostic laparoscopy was then performed to determine visceral organ involvement and establish a diagnosis along with pathomorphological verification. After that evacuation, sanation and drainage of the hematoma was done.