Conservative management of a progressively growing rectus sheath hematoma presented in a patient with chronic renal failure: A case report

Introduction: Rectus sheath hematoma is a rare but an important clinical entity in the differential diagnosis of abdominal pain. It is often a self-limiting condition that can be managed successfully in conservative measures. If not recognized, it can lead to unnecessary emergency surgical procedures. A 55-year-old male patient suffering from chronic renal failure and cardiomyopathy presented with a progressively growing abdominal mass diagnosed to be a bilateral rectus sheath hematoma. Despite many complications related to alteration of general status, electrolyte imbalance and coagulation problems, conservative management proved successful, while prompt surgical intervention could have ended in death in such a fragile patient. The advent of radiology and computer tomography has noticeably increased the diagnosis rate of rectus sheath hematoma. Despite the classic opinion that surgery should be reserved only for those patients with hemodynamic instability or complications such as infection or free intraabdominal rupture, the trend to treat conservatively with great patience is emphasized.