Use of haemostatic matrix in management of rectus hematoma in an anticoagulated patient: a case report
© licensee BioMed Central Ltd. 2009
Received: 3 March 2009
Accepted: 11 June 2009
Published: 7 July 2009
Rectus sheath hematoma may present as a painful mass in the anterior abdominal wall. The underlying reasons may vary, while anticoagulant use and thromboembolism prophylaxis are documented causes. Treatment is mostly conservative however interventional procedures can be required. We herein present a case of 76-year-old patient with an uncontrolled rectus hematoma despite surgical hemostasis. The patient was treated succesfully by applying hemostatic matrix (Floseal).
Rectus sheath hematoma may present as a painful lesion with or without a visible mass on the anterior abdominal wall. The underlying reasons may vary. Etiology may consist of any kind of trauma including abdominal surgery or even a strenuous cough . Oral anticoagulant usage and thromboembolism prophylaxis with heparins are also well-documented causes of rectus sheath hematoma . The treatment of rectus sheath hematoma is conservative in many cases - however interventional procedures can be required in some cases [4, 5].
Daily drainage was 20 and 10 ml. on day-1 and -2. Ecchymosis started to fade away. Patient complained no pain. Drain was removed after 48 hours and the patient was discharged. Control examinations on 3, 7, and 15 day after were completely alright.
The treatment of rectus sheath hematoma is mostly conservative - however surgical interventions including laparotomy  or endovascular embolizations have been reported in patients develop clinical deterioration . This is especially the case for some patients on anticoagulant use which may cause life-threatening abdominal wall hematomas especially when concomitant systemic disorders also exist .
The use of hemostatic matrix in general surgery field is rather limited with sporadic applications in patients suffered abdominal traumas . Very recently, Izzo et al. reported a large prospective study of 237 consecutive patients undergoing major hepatic surgery and stated that the application of a hemostatic matrix provided rapid and effective intraoperative control of mild to severe bleeding from the liver edge, even in patients with prolonged bleeding times resulting from cirrhosis . To the best of our knowledge no report has been published to date about the use of hemostatic matrix in rectus muscle hematoma or other abdominal wall injuries. Regarding in-muscle tissue experience, there is only one report describing the use of this matrix in successful repair of iatrogenic diaphragmatic injury during laparoscopy instead of a formal suture repair . It has been shown experimentally that hemostatic matrix has no adverse effect on the function of the neurovascular bundles . This may be a clue for its safe use in muscles which need an intact neurovascular supply.
In fact, hemostatic matrix is a quite expensive commercial material. It is more logical to use it in major surgical procedures and acute life-threatening hemorrhages. However its application may also be valuable and in some moderately critical patients with severe concomitant diseases and coagulation disorders to avoid long hospital stays, longer immobilization and higher in-hospital care cost.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Linhares MM, Lopes Filho GJ, Bruna PC, et al: Spontaneous hematoma of the rectus abdominis sheath: a review of 177 cases with report of 7 personal cases. Int Surg. 1999, 84: 251-257.PubMedGoogle Scholar
- Weinsheimer RL, Libby E, Howdieshell TR: Life-threatening abdominal wall hematoma in a chronic renal failure patient after a single dose of enoxaparin. Am Surg. 2005, 71: 132-134.PubMedGoogle Scholar
- Verhagen HJ, Tolenaar PL, Sybrandy R: Haematoma of the rectus abdominis muscle. Eur J Surg. 1993, 159: 335-338.PubMedGoogle Scholar
- Cherry WB, Mueller PS: Rectus sheath hematoma: review of 126 cases at a single institution. Medicine (Baltimore). 2006, 85: 105-110. 10.1097/01.md.0000216818.13067.5a.View ArticleGoogle Scholar
- Wai-Kit Ma, Terence Ming-Kit Fung, Yuk-Hoi Lam, James Yun-Wong Lau: Rectus sheath haematoma requiring laparotomy. Surgical Practice. 2006, 10: 45-46. 10.1111/j.1744-1633.2006.00287.x.View ArticleGoogle Scholar
- Oz MC, Rondinone JF, Shargill NS: FloSeal Matrix: new generation topical hemostatic sealant. J Card Surg. 2003, 18: 486-493. 10.1046/j.0886-0440.2003.00302.x.View ArticlePubMedGoogle Scholar
- Angioli R, Muzii L, Montera R, Damiani P, Bellati F, Plotti F, Zullo MA, Oronzi I, Terranova C, Panici PB: Feasibility of the use of novel matrix hemostatic sealant (FloSeal) to achieve hemostasis during laparoscopic excision of endometrioma. J Minim Invasive Gynecol. 2009, 16: 153-156. 10.1016/j.jmig.2008.11.007.View ArticlePubMedGoogle Scholar
- Moriarty KT, Premila S, Bulmer PJ: Use of FloSeal haemostatic gel in massive obstetric haemorrhage: a case report. BJOG. 2008, 115: 793-795. 10.1111/j.1471-0528.2007.01654.x.View ArticlePubMedGoogle Scholar
- Mathiasen RA, Cruz RM: Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in children undergoing adenoidectomy. Otolaryngol Head Neck Surg. 2004, 131: 601-615. 10.1016/j.otohns.2004.05.025.View ArticlePubMedGoogle Scholar
- Mathiasen RA, Cruz RM: Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope. 2005, 115: 899-902. 10.1097/01.MLG.0000160528.50017.3C.View ArticlePubMedGoogle Scholar
- Stacey MJ, Rampaul RS, Rengaragan A, Duffy JP, Macmillan RD: Use of FloSeal matrix hemostatic agent in partial splenectomy after penetrating trauma. J Trauma. 2008, 64: 507-508.PubMedGoogle Scholar
- Izzo F, Di Giacomo R, Falco P, Piccirillo M, Iodice R, Orlando AP, Aprea P, Cremona F, Di Marzo M, Idà DN, Mastro AA, Curley SA: Efficacy of a haemostatic matrix for the management of bleeding in patients undergoing liver resection: results from 237 cases. Curr Med Res Opin. 2008, 24: 1011-1015. 10.1185/030079908X280392.View ArticlePubMedGoogle Scholar
- Bhayani SB, Grubb RL, Andriole GL: Use of gelatin matrix to rapidly repair diaphragmatic injury during laparoscopy. Urology. 2002, 60: 514-10.1016/S0090-4295(02)01771-5.View ArticlePubMedGoogle Scholar
- Zeltser I, Dugi D, Gupta A, Park S, Kabbani W, Cadeddu J: Does topical haemostatic agent have an adverse effect on the function of the prostatic neurovascular bundle?. BJU Int. 2008, 102: 1005-1007. 10.1111/j.1464-410X.2008.07828.x.View ArticlePubMedGoogle Scholar
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