From the Research
The management of rectus sheath hematoma should primarily involve conservative treatment, including bed rest, analgesics, and hemostatic agents such as carbazochrome and tranexamic acid, as evidenced by a recent case report 1. This approach is supported by the most recent and highest quality study, which demonstrated the effectiveness of conservative treatment in managing rectus sheath hematoma. The key components of conservative treatment include:
- Bed rest to reduce physical strain on the abdominal wall
- Analgesics, such as acetaminophen or NSAIDs, to manage pain
- Hemostatic agents, such as carbazochrome and tranexamic acid, to control bleeding
- Vital sign monitoring and serial hemoglobin measurements to detect ongoing bleeding
- Abdominal binders for comfort and support In addition to these measures, it is essential to consider the patient's clinical status and the severity of the hematoma. For patients on anticoagulants, these medications should be held and potentially reversed depending on the severity of bleeding, as suggested by earlier studies 2, 3, 4, 5. However, the most recent study 1 provides the strongest evidence for the use of conservative treatment, including hemostatic agents, in managing rectus sheath hematoma. In more severe cases with hemodynamic instability or expanding hematomas, interventional approaches may be necessary, including blood transfusions, arterial embolization, or surgical evacuation. Overall, the management of rectus sheath hematoma requires a tailored approach that takes into account the patient's individual clinical status and the severity of the hematoma.