++
Mild trauma may produce hematomas of the rectus sheath. This injury results in intense abdominal pain, which can mimic an acute abdomen. The diagnosis is difficult by physical exam since most hematomas are in the posterior rectus sheath and are not palpable or visible. Palpation of the abdominal wall may reveal a tender mass that is accentuated by contraction of the rectus. Ultrasound and CT can confirm the diagnosis.
++++++++++
Major traumatic force, especially when belted in a vehicle crash, may result in a massive abdominal wall hematoma that requires intervention. Active extravasation, demonstrated by a contrast blush within the hematoma, suggests active bleeding within the hematoma.
+++
Management and Disposition
++
Assuming that there is no underlying blood dyscrasia or coagulopathy, hematomas of the rectus sheath usually resolve in 1 to 2 weeks. Expanding abdominal wall hematomas with active extravasation of blood may require embolization by interventional radiology.
++
Fothergill sign is enhancement of a rectus sheath hematoma when the abdominal wall is tensed. The mass should not cross the midline and should be easier to palpate with abdominal muscle contractions. Intra-abdominal masses are more difficult to palpate with such contractions.
Carnett sign is also assessed after the abdominal wall muscles are tensed; decreased pain suggests an intra-abdominal source, whereas increased pain suggests an abdominal wall source.
++