Spontaneous rectus sheath hematoma as a differential diagnosis for localized abdominal swelling in chronic liver disease: A rare case report

Key clinical message: Spontaneous rectus sheath hematoma is a rare complication in chronic liver disease patients. Early clinical suspicion with prompt radiological evaluation is crucial for accurate diagnosis and timely management.

Abstract: Spontaneous rectus sheath hematoma can present as an acute abdomen in the emergency department. The rupture of the upper and lower epigastric arteries and their branches is the main cause of hematoma formation. Hepatic dysfunction can affect the clotting process, increasing the risk of hematoma development. Computed tomography is the preferred diagnostic tool. Most hematomas can be managed conservatively, with only a few requiring minimal intervention or surgical management. We report an uncommon instance of spontaneous rectus sheath hematoma in a patient with chronic liver disease presenting with painful abdominal distention, mimicking a hernia and initially posing a diagnostic challenge. The rectus sheath hematoma was definitively diagnosed through clinical and radiological evaluation and subsequently evacuated with successful outcomes.