Güven TEKBAŞ, İbrahim TAÇYILDIZ, Sadullah GİRGİN, Akın ÖNDER, Murat KAPAN, Metehan GÜMÜŞ, Abdullah BÖYÜK

A conservative approach to rectus sheath haematomas

Amaç: Rektus kılıfı hematomu (RKH), epigastrik damarların veya rektus kası liflerinin yırtılması sonucu en sık infraumblikal bölgede meydana gelir. Çoğu kez neden travma olup, nadiren spontan olarak oluşur. Genellikle yanlış tanı veya tanıda gecikmeler gereksiz cerrahi girişimlerin uygulanmasıyla sonuçlanır. Metod: Aralık 2008 - Eylül 2009 tarihleri arasında rektus kılıfı hematomu tanısıyla kliniğimize yatırılarak tedavi edilen 5 hasta demografik özellikler, klinik ve radyolojik bulgular ve hastanede yatış süreleri açısından retrospektif olarak incelendi. Bulgular: Hastaların ortalama yaşı 67 (59-76) yıl olup, bütün hastalar kadındı. Hastaların en az birinde bir sistemik hastalık mevcuttu. Hastalardan tamamı oral antikoagulan kullanıyordu ve hiçbirinde travma öyküsü mevcut değildi. Fizik muayenede, 3 hastada sol alt, 1 hastada sağ alt kadranda 1 hastada ise sol üst kadranda palpabl kitle mevcuttu. Tomografik olarak RKHnun tipi, 1 hastada Tip 1, 3 hastada Tip 2 ve 1 hastada Tip 3 idi. Tüm hastalara konservatif tedavi başlandı. Antikoagulan kullanımı kesildi. Hastaların ortalama hastanede kalış süreleri ortalama 8 gündü. Birinci ayın sonunda yapılan kontrol bilgisayarlı tomografide; Tip 1 RKHlı olguda kitlenin tamamen kaybolduğu, diğer 4 hastada ise kitle boyutlarının belirgin olarak azaldığı tespit edildi. Sonuç: Akut karın nedeniyle hastaneye başvuran, antikoagulan ilaç kullanım öyküsü, palpabl kitlesi ve anemisi olan ileri yaş grubundaki özellikle bayan hastalarda, ayırıcı tanıda RKH göz önünde bulundurulması, gereksiz cerrahi girişimlerin önlenmesini ve konservatif tedavinin başarıyla uygulanmasını sağlar.

Rektus kılıfı hematomuna konservatif yaklaşım

Aim: Rectus sheath haematoma (RSH) is the result of a rupture of epigastric vessels or rectus muscle occurring mostly in infraumblical region. Etiological factor is predominantly trauma and rarely spon- taneous. Generally, misdiagnosed or delays in diagnosis result in un- necessary surgical intervention. Method: Between December 2008 and September 2009, five patients diagnosed for RSH in our hospital retrospectively analyzed in terms of the demographical characteristics, clinical and radiological findings and length of stay in hospital. Result: The average age of the patients was 67 (59-76) years and all were female. At least one of the patients had a systematic disease. All the patients were using anticoagulant and none of them had trauma story. On physical examination, we determined palpable masses loca ted as follows; in left lower quadrant of three patients, in right lower quadrant of one patient and in left upper quadrant of one patient. The types of RSH in radiological imaging were Type 1 in one patient, Type 2 in three patients and Type 3 in one patient. Anticoagulant treatments were stopped and all patients were treated conservative- ly. The average stay in hospital time of the patients was 8 days. The computed tomography control at the end of the first month revealed that the mass disappeared in cases with Type 1 RSH while the other four cases had a marked decrease in the mass size. Conclusion: RSH should be taken into consideration in differential diagnosis when elder patientsespecially femaleswith anemia, pal- pable mass, anticoagulant medication history admitted to clinics with acute abdomen. Early diagnosis of RSH provides the preventing of the unnecessary surgical interventions and determines the success of con- servative treatment.

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