Rectus Sheath Hematoma Due to Low Molecular Weight Heparin in a COVID-19 Patient in Turkey

Abstract

This case report presents a large left rectus sheath hematoma (RSH) case developed in a COVID-19 patient who had received no anticoagulant therapy before hospital admission. It discusses the patient’s diagnosis and treatment process. A 78-year-old woman was admitted to the ED with acute cough and shortness of breath. On CT scan, the pulmonary findings were consistent with COVID-19 pneumonia. Subcutaneous enoxaparin sodium was started to the patient, in accordance with the COVID-19 treatment guidelines applied in Turkey. On the ninth day after admission, her hemoglobin level decreased to 7.3 g/dL. At that point, her blood pressure was 84/52 mmHg, and her heart rate was 120 beats/min. There was a mass in the left lower quadrant on the physical exam. CT examination of the abdomen and pelvis showed a left inferior RSH approximately 9 cm wide. Enoxaparin sodium was stopped. Vital signs monitoring and fluid replacement were begun. One week after the diagnosis of RSH, a CT of the abdomen and pelvis was performed. The scan showed no significant increase in the size of the hematoma. On the 18 th day after admission, the patient was discharged because her hemoglobin value, which was 10.2 g/dL at that point, had not decreased, her vital signs were stable, and her treatment for COVID-19 was completed. From the moment of diagnosis to discharge, the patient required no interventional or surgical procedures.

Severe Retroperitoneal Hemorrhage in a COVID-19 Patient on a Therapeutic Dose of Low Molecular Weight Heparin: A Case Report

“…Yeoh et al [ 17 ] recommend suspecting it in patients with significant groin, flank, abdominal, back pain, or hemodynamic instability after an interventional procedure or in anticoagulated patients. As shown by Kalayci [ 11 , 12 ], the ideal and straightforward diagnostic method is to check the hemoglobin level regularly. A contrast-enhanced CT scan of the abdomen remains the imaging modality of choice for early detection and prompt intervention [ 17 ].…”

“…On the other hand, Tanal et al's [2] findings of non-traumatic focused hemorrhages are unexpected. Several clinical reports [7][8][9][10][11][12] describing cases of severe spontaneous abdominal or retroperitoneal bleeding were published during the most fulminant phase of the pandemic. Retroperitoneal hematoma is a rare radiologically diagnosed complication, defined as bleeding in the retroperitoneal space, usually without associated trauma or iatrogenic manipulation.…”

Heparin-induced rectus sheath hematoma in a COVID-19 patient with pulmonary emboli: a case report and literature review

“…Kalayci et al recommended that enoxaparin must be discontinued immediately upon the detection of RSH. The patient's vital signs, abdomen condition, and hemoglobin levels should be evaluated regularly (3). Analgesia, management of predisposing factors, and discontinuation of anticoagulation are all effective treatments for most RSHs.…”

Acute retroperitoneal hematoma following severe Covid-19 and the use of anticoagulants

“…Global upsurge in COVID19 cases has been marked with systemic manifestations. Clinical studies have indicated thromboembolic events and vascular injuries in COVID19 patients [ 1 , 2 ]. In such cases, morbidities, poor prognosis and even mortality is reported.…”