Rectus Sheath Hematoma in COVID-19 Patients

INTRODUCTION: The COVID-19 pneumonia epidemic that started in 2020 and the management of its cases are not completely clear. Moreover, the process becomes more complicated in patients with comorbidities. In this study, we presented COVID-19 pneumonia patients diagnosed with rectus sheath hematoma (RSH).
METHODS: We retrospectively analyzed 12 patients that we followed up in the pandemic clinic between March 2020 and September 2021. The examinations performed at admission, the blood values and imaging findings in the detection of RSH, and the procedures performed were recorded.
RESULTS: Six of our cases were male and six were female, and the mean age was 77 (range: 68–89) years. In treatment protocols, low-molecular-weight heparin 0.6 milliliter and prednol 40 milligrams (IV) were administered twice a day. The diagnosis of RSH was made on the 8th (6–12) day on average of hospitalization and the start of treatment. A possible intra-abdominal connection of the hematoma or other intra-abdominal bleeding foci were excluded by computed tomography (CT) in all cases. After LMWH was discontinued, all patients were followed conservatively by recording their daily examinations and hematoma diameters, and the hematoma stopped and regressed spontaneously. All patients were followed conservatively and bleeding was successfully stopped. No morbidity or mortality associated with RSH was observed.
DISCUSSION AND CONCLUSION: CT is the main tool used to determine the origin, amount, and type of bleeding in the diagnosis of RSH. Although it is a self-limiting entity, it may rarely require intervention. Hypercoagulation appears to play a key role in the pathogenesis of COVID-19. Side effects seen while intervening in the coagulation cascade require rapid diagnosis and treatment.