Rectus sheath haematoma after laparotomy.

ABSTRACT

Case (1) - A 32 years old, P2+1 lady was referred to Central Women's Hospital (CWH), Yangon with shock for 18 hours following laparotomy for ruptured ectopic pregnancy at Tike Gyi Hospital. Resuscitated measures were carried out. The urgent re-laparotomy was done with the diagnosis of intra-abdominal bleeding. The operative findings were rectus sheath haematoma (about 100ml), haemoperitoneum (about 300 ml) and intact left tubal ligation stump. The source of bleeding was from inferior epigastric vessels. The bleeding point was secured and abdominal and sub-rectus sheath drains were inserted. At post operative period, her condition deteriorated and she had acute renal failure (ARF) and disseminated intravascular coagulopathy (DIC). She was referred to renal medical unit on post-operative day 2 for peritoneal dialysis. However, she expired on the next day. Case (2) - A 28years old, G2 P1+0 lady was admitted to CWH, Yangon for previous one scar with twins pregnancy at 37 week gestation. Elective Caesarean Section was done at 38 week gestation with the indication of previous one scar with twins pregnancy. At 4 hours after operation, she had shock with clinical features of intra-abdominal bleeding and abdominal wound haematoma. Urgent laparotomy was undertaken and the operative findings revealed the 9x10 cm right sub-rectus sheath haematoma with active bleeding from right inferior epigastric vessels and 1000 ml of haemoperitoneum. Her post-operative period was uneventful and she was discharged on post-operative day 10.