Risk Factors in the Development of Rectus Sheath Hematoma and Treatment Modalities.

Background: In this study,we aim to present the clinical features of patients with rectus sheath hematoma(RSH), as well as the condition's therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment for spontaneous RSH between the years 2010 and 2020. The demographic and clinical features of the patients, as well as follow-up parameters, were analyzed retrospectively. Results: Our study included 53 patients. The number of female patients was twice as many as the number of male patients. The median age was 65.7 +-14.68 years, and 63.3% of the patients were over the age of 65. The most frequently used anticoagulant was warfarin (30.1%), and it was most often used for heart diseases (54.7%). The international normalized ratio value at the time of admission to the hospital was 1.93+1.18, and the hemoglobin value was 11.2 gr/dl. The average hematoma diameter was 74 mm, and the most common stage was typeI (75.6%). Of the patients, 90.6% were followed up conservatively. The average duration of hospital stay was 15.1 days, and mortality occurred in eight patients during their hospital stay. Conclusion: Spontaneous RSH should be consideredfor elderly female patients who have used anticoagulants. Most patients are followed up medically, but mortality is still high.

Prolapsed giant rectal gastrointestinal stromal tumor presented with incarceration A rare case of emergency rectal lesion.

Prolapse of the tumor is an extremely rare clinical presentation in patients with rectal gastrointestinal stromal tumor (GIST). A 79-year-old male patient was consulted in the in-patient ward of internal medicine clinic of our hospital due to his incarcerated hemorrhagic mass protruding from the anal canal. Anal inspection revealed an incarcerated prolapsed hemorrhagic mass larger than 10 cm in diameter that looked like a cauliflower. The incarcerated rectal GIST protruding from the anal canal was removed by transanal excision under the emergency conditions. Clean surgical margins were obtained. No postoperative complications occurred. The histological diagnosis of high-risk GIST was made. Imatinib mesylate treatment was started postoperatively. The colorectum are the less common primary sites in adult GISTs (5%). Giant GISTs of the anorectum represent a real potential for anorectal emergency. They may be involved in rectal bleeding, obstruction, prolapse or incarceration. Prolapse of the tumor is an extremely rare clinical presentation in cases of rectal GISTs, and only a few cases have been reported in the medical literature so far. Complete surgical resection with en bloc excision of the tumor is the treatment of choice. Lower rectal GISTs are a rare entity that requires multidisciplinary management and long-term surveillance. We recommend, in case of lower rectal GIST, to perform an initial transanal local excision that achieves the essential R0 resection and define the risk of aggressive behavior and the involvement of the resection margins. Patients' close follow-up is mandatory to disclose as soon as possible local recurrences or metastases. Preoperative imatinib mesylate therapy and downstaging of the tumor may play an important role. KEY WORDS: Gastrointestinal stromal tumor, Incarceration, GIST, Prolapse, Transanal excision.