Bladder perforation and vesico-haematoma fistula: an uncommon complication of rectus sheath haematoma
  • Novena Lin Sing Cheng
    Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
  • Chung Wai Wong
    Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
  • Wen Ming Yu
    Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
  • Kim Hung Tsang
    iRad Medical Diagnostic Centre, Jordan, Hong Kong

Keywords

Rectus sheath haematoma, acute abdomen, epigastric vessel injury, bladder perforation, vesico-haematoma fistula

Abstract

Introduction: Rectus sheath haematoma (RSH) has become increasingly common but is often underdiagnosed. Prompt diagnosis will avoid unnecessary investigations and procedures, resulting in early treatment and a better outcome.
Case description: We described a case of a spontaneous RSH with intraperitoneal extension and formation of a vesico-haematoma fistula, which was initially misdiagnosed as a urinary tract infection. The diagnosis was made ten days after admission, when a CT scan showed an over-16 cm RSH with intraperitoneal extension, bladder perforation and a vesico-haematoma fistula. The patient was managed conservatively.
Discussion: RSH accounts for less than 2% of acute abdomen cases and is often unrecognised. Its presentation can mimic other intra-abdominal pathologies, and the diagnosis is often delayed or missed. Complications can arise from an RSH although it is generally viewed as a self-limiting condition.
Conclusion: RSH has become increasingly common, and we would like to highlight the need to include abdominal wall pathologies in the initial differential diagnoses of acute abdomen to avoid delay in diagnosis.

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    Published: 2024-03-25
    Issue: 2024: Vol 11 No 4 (view)


    How to cite:
    1.
    Cheng NLS, Wong CW, Yu WM, Tsang KH. Bladder perforation and vesico-haematoma fistula: an uncommon complication of rectus sheath haematoma. EJCRIM 2024;11 doi:10.12890/2024_004362.