# Rectus sheath hematoma causing cecal perforation: a case report

## TL;DR

A rare case of rectus sheath hematoma led to cecal perforation in a 49-year-old man, requiring surgical intervention.

## Contribution

This case report highlights an unusual complication of rectus sheath hematoma causing hollow viscus perforation.

## Key findings

- The patient developed cecal perforation due to the mass effect of an enlarging rectus sheath hematoma.
- Conservative management of the hematoma failed, necessitating surgical intervention with ileocecectomy.
- The patient had a history of smoking and recent COVID-19 infection, which may have contributed to the condition.

## Abstract

Rectus sheath hematoma is a rare condition caused by bleeding from the epigastric arteries, with an incidence of 1.2–1.5 cases per year. We present a 49-year-old male with a smoking history and recent corona virus disease 2019 (COVID-19) infection who presented with symptoms of an upper respiratory infection and suspected venous thromboembolism. Imaging revealed bilateral pulmonary emboli and a left rectus sheath hematoma, which was initially managed conservatively. However, the patient’s condition worsened with a significant drop in hemoglobin and development of encephalopathy. Imaging showed an enlarging hematoma, leading to transfusion and selective embolization. On day 8, the patient developed generalized abdominal pain, and imaging confirmed a hollow viscus perforation. An exploratory laparotomy revealed cecal perforation due to mass effect from the hematoma. An ileocecectomy was performed.