LAUSR

A 71-year-old man with an 18-year history of hemodialysis was admitted to our hospital because of lumbar spinal stenosis and underwent L3-L5 posterior laminectomy. On the 9th day after the operation, 30 minutes after hemodialysis was started, he noted right upper abdominal pain that suddenly worsened. He had a slight bulge in the abdomen and strong tenderness, and hemorrhaging in the abdominal wall was suspected because Carnett’s sign was positive. Abdominal ultrasonography (Picture 1) and computed tomography (Picture 2) were performed. He was diagnosed with rectus sheath hematoma (RSH), a spindle-shaped hematoma centered on the right rectus abdominis muscle. As his hemodynamics were stable and no rapid progression of anemia was observed, we performed conservative treatment, after which the hematoma shrank without rebleeding. Risk factors of RSH, including anticoagulants, aging, cough, trauma, and obesity, have been reported (1, 2). In our case, heparin use and compression by a corset were believed to be involved in the development.