Heparin-induced Rectus Sheath Hematoma in a COVID-19 Patient with Pulmonary Emboli: A Case Report and Literature Review

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Zandbaf Tooraj; Kalantari Mohammad Ebrahim; Azadmanesh Yeganeh; Sherafati Hamzeh; Bagherzadeh Ali Akbar

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Journal Paper

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Journal: Iranian Red Crescent Medical Journal Year:2022 | Volume:24 | Issue:4 Page(s): 0-0

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Title

Heparin-induced Rectus Sheath Hematoma in a COVID-19 Patient with Pulmonary Emboli: A Case Report and Literature Review

Author(s)

Keywords

Anticoagulant therapy

Case report

Coronavirus

COVID-19

Heparin

Rectus sheath hematoma

Abstract

Background: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with Heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities. Case presentation: The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated COVID-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism,therefore, the therapeutic dose of Heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical,nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7. 9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle. Conclusion: In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.

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APA: Copy

Zandbaf, Tooraj, Kalantari, Mohammad Ebrahim, Azadmanesh, Yeganeh, Sherafati, Hamzeh, & Bagherzadeh, Ali Akbar. (2022). Heparin-induced Rectus Sheath Hematoma in a COVID-19 Patient with Pulmonary Emboli: A Case Report and Literature Review. IRANIAN RED CRESCENT MEDICAL JOURNAL (IRCMJ), 24(4), 0-0. SID. https://sid.ir/paper/994355/en

Vancouver: Copy

Zandbaf Tooraj, Kalantari Mohammad Ebrahim, Azadmanesh Yeganeh, Sherafati Hamzeh, Bagherzadeh Ali Akbar. Heparin-induced Rectus Sheath Hematoma in a COVID-19 Patient with Pulmonary Emboli: A Case Report and Literature Review. IRANIAN RED CRESCENT MEDICAL JOURNAL (IRCMJ)[Internet]. 2022;24(4):0-0. Available from: https://sid.ir/paper/994355/en

IEEE: Copy

Tooraj Zandbaf, Mohammad Ebrahim Kalantari, Yeganeh Azadmanesh, Hamzeh Sherafati, and Ali Akbar Bagherzadeh, “Heparin-induced Rectus Sheath Hematoma in a COVID-19 Patient with Pulmonary Emboli: A Case Report and Literature Review,” IRANIAN RED CRESCENT MEDICAL JOURNAL (IRCMJ), vol. 24, no. 4, pp. 0–0, 2022, [Online]. Available: https://sid.ir/paper/994355/en

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