RSH

 Q: During repair/evacuation of rectus sheath hematoma (RSH) extreme care should be taken to avoid ligation of epigastric vessels? 

 A) True 

 B) False

 Answer: B

Evacuation of RSH in a hemodynamically unstable patient is performed for two reasons. First, to relieve pressure on adjacent abdominal organs, a major cause of intense pain to the patient. The second reason is to ligate the bleeding vessel. Fortunately, in the case of RSH, ligation of either superior or inferior epigastric vessel does not bear any major consequences due to an ample supply of collateral vessels on the ipsilateral side. This blood supply gets reinforced by both superior and inferior epigastric vessels from the contralateral side of the abdomen. 

Hematoma is evacuated once ligation and hemostasis are achieved. Evacuation of RSH leaves a huge dead space. A suction catheter is left in place to remove the inflammatory fluid.

#surgical-critical-care

References:

1. Salemis NS, Gourgiotis S, Karalis G. Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study. Int J Surg 2010; 8:290. 

2. Rimola J, Perendreu J, Falcó J, et al. Percutaneous arterial embolization in the management of rectus sheath hematoma. AJR Am J Roentgenol 2007; 188:W497.