A 35 years old woman after transfemoral renal angiography developed sudden pain in right lower quadrant. On examination there was a palpable mass in right lower quadrant. Abdominal CT. Scan showed RECTUS SHEATH hematoma at same area. By conservative managment she improved within two weeks.

Musculocutaneous pedicled/ free flaps are an essential prerequisite for reconstructive surgery.Amongst the trunk muscles commonly harvested for flaps, the trapezius and RECTUS abdominis provide satisfactory coverage for cranial and trunk defects. unilateral/ bilateral or partial congenital absence of trapezius muscle is well documented and may result in muscular imbalances compromising posture and limb movements. During routine cadaveric dissection, we encountered a case of bilateral partial absence of occipital part of the trapezius muscle. Concurrently, the ventral abdominal musculature displayed the aponeurosis of transversus abdominis muscle solely forming the posterior wall of the RECTUS SHEATH. These conjointly occurring anomalies advocate a compensatory strengthening of the anterior wall of RECTUS SHEATH in response to the congenital absence of occipital part of the trapezius, probably to counteract the postural instability. The present study focuses on recognition of compensatory mechanisms resulting from congenital variations as identification of such processes may prevent chronic debilitating conditions.

RECTUS SHEATH hematoma (RSH) mainly occurs due to anticoagulant therapy, and blunt traumas may also rarely cause RSH. However, there is no case report published on the follow‑, up and treatment process of RSH after stabbing. A 60‑, year‑, old man was admitted after stabbing himself for suicide. The patient had a history of using clopidogrel and oral antidiabetic drugs. On physical examination, there were many entrance holes (more than 10) in the anterior abdominal wall, the largest of which was in the periumbilical region, approximately 30 mm in size and reaching toward the intra‑, abdominal cavity. On computed tomography, there was a RSH of roughly 95 mm × 55 mm and a wound about 25 mm in diameter on the lateral side of the umbilicus, including hyperdense areas thought to belong to active extravasation. Due to a hemoglobin level decrease, hypotension, and tachycardia, he underwent an emergency laparotomy. On exploration, there was no need to intervene in the RSH. The patient was discharged without complications on the 7th postoperative day.

Spontaneous RECTUS SHEATH hematoma (RSH), a rare complication of anticoagulation therapy, can pose significant diagnostic and management challenges. We present the case of an 87-year-old woman with atrial fibrillation, hypertension, and chronic kidney disease (CKD) who developed spontaneous RSH while on apixaban. She presented with acute abdominal pain and a palpable mass, accompanied by anemia and coagulopathy. Non-contrast computed tomography (CT) confirmed a large RECTUS SHEATH hematoma. Conservative management, including discontinuation of apixaban, administration of tranexamic acid, and close monitoring, led to clinical improvement without requiring invasive intervention. This case underscores the importance of recognizing RSH in anticoagulated patients, particularly elderly individuals with renal impairment. Clinicians must maintain a high index of suspicion for atypical bleeding sites in patients on direct oral anticoagulants (DOACs) and consider conservative strategies when managing hemodynamically stable cases. The report highlights the need for individualized risk-benefit assessments when resuming anticoagulation and emphasizes patient education on bleeding risks.

Purpose: To compare the results of lateral RECTUS resection and medial RECTUS rerecession on the patients with residual esotropia at Emam Hossein Medical Center, since2004 to 2005. Patients &Methods: This double blind controlled clinical trial study was performed on 25 patients with residual esotropia by consecutive selection. After signing of consent form by the patients or their parents, cyclorefraction, best corrected visual acuity, deviation, near point of convergence, medial RECTUS function were measured by our orthoptist. On table of operation, if FDT was positive, MR ReRec. and if it was negative, both methods were done by random selection. 12 patients were operated with rerecession of medial RECTUS (cases) and 13 patients were operated with lateral RECTUS resection (controls). Patients were re-examined-after 1.5 months follow up by the same orthoptist who did not know the type of operation. The results were analysed by T, Fisher exact and X2 tests. Results: 15 (60%) of patients were female and 10 (40%) were male. The patients were matched as their spherical equivalent; best corrected visual acuity, degree of deviation and near point of convergence. The success rate of the case and control groups were 67% and 54% respectively, but the difference was not statistically significant. Each millimeter of MR ReRec. has corrected 7.5 pd and each millimeter of LR Res. Has corrected 2.5 pd of residual esotropia. Medial RECTUS mild underaction were seen in 50% of cases, but only 17.5% of them showed increased near point of convergence. There were no muscle slippage or lost, exotropia and scleral perforation. Conclusion: Considering the results of this study, lateral RECTUS resection can be substituted with medial RECTUS rerecession in special situations. Medial RECTUS underaction was relatively mild and would not produce cosmetic problem.