SHM Converge Scientific Abstract ePoster Gallery-Cough Breaks More Than Just Silence - Spontaneous Rectus Sheath Hematoma After Coughing

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This case report describes a spontaneous rectus sheath hematoma occurring after intense coughing and straining during a bowel movement in a patient not taking anticoagulants and with no traumatic injury. Rectus sheath hematoma is often associated with anticoagulation, but this case emphasizes that it can also occur without it.<br /><br />Typical risk factors include pregnancy, obesity, older age, hypertension, and female sex. Patients commonly present with acute abdominal pain and a palpable mass, though symptoms such as fever, nausea, weakness, and chills may also occur. The condition results from injury to the epigastric artery, usually due to trauma, but in this case it was likely triggered by increased intra-abdominal pressure from persistent coughing and Valsalva maneuver.<br /><br />The report highlights that recent viral illness with severe cough should raise suspicion for this diagnosis, especially in patients with sudden severe abdominal pain. Because rectus sheath hematoma is not always considered in patients without anticoagulation, diagnosis can be delayed. Hemoglobin may initially remain stable, so serial exams and repeat laboratory testing may be necessary.<br /><br />Prompt imaging is essential, and early interventional or diagnostic procedures may be needed when active bleeding is present to prevent hemodynamic instability. Overall, the case reinforces the importance of including rectus sheath hematoma in the differential diagnosis for acute abdominal pain, even in patients without classic risk factors.

Asset Subtitle

Tabitha Gruskowski

Meta Tag

Author List Radha Devi Radhakrishna Pillai, Tabitha Gruskowski

Category Clinical Vignettes

Concept Hematoma

Concept Abdominal Pain

Concept Imaging

Concept Active Extravasation

Concept Cough

Distinguished Non-Finalist

Presenter Organization Washington University

Presenting Author Tabitha Gruskowski

Track Adult

Keywords

rectus sheath hematoma

spontaneous hematoma

acute abdominal pain

cough-induced injury

Valsalva maneuver

epigastric artery

non-anticoagulated patient

abdominal mass

diagnostic imaging

differential diagnosis

Hematoma

Abdominal Pain

Imaging

Active Extravasation

Cough