Spontaneous Rectus Sheath Hematoma in Pregnancy Complicated by the Development of Transfusion Related Acute Lung Injury: A Case Report and Review of the Literature

Abstract

Background Rectus sheath hematoma (RSH) represents a rare, but serious cause of abdominal pain.

Case Here we discuss the case of a healthy multigravida female who presented at 28 weeks gestation with spontaneous RSH. Conservative management with multiple blood transfusions led to the development of transfusion related acute lung injury (TRALI) and intensive care unit admission. She was managed with noninvasive ventilatory support, gradually improved, and was weaned of ventilation. After hospital discharge, she progressed to full term and delivered a viable male infant vaginally at 37 weeks gestation.

Conclusion Review of the literature demonstrates 13 cases of RSH in pregnancy, including our own. No other cases were complicated by transfusion related morbidity. RSH and TRALI are rare, but life threatening entities that can complicate pregnancy.

Keywords

pregnancy - rectus sheath hematoma - respiratory failure - transfusion

• References

• 1 Tolcher MC, Nitsche JF, Arendt KW, Rose CH. Spontaneous rectus sheath hematoma pregnancy: case report and review of the literature. Obstet Gynecol Surv 2010; 65 (8) 517-522
• 2 Wai C, Bhatia K, Clegg I. Rectus sheath haematoma: a rare cause of abdominal pain in pregnancy. Int J Obstet Anesth 2015; 24 (2) 194-195
• 3 Brunicardi F. Charles. Schwartz Essentials of Surgery. 10th ed. New York: McGraw-Hill, Health Pub. Division; 2015. . Print
• 4 Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood 2005; 105 (6) 2266-2273
• 5 Chang W, Dronen SC. Rectus Sheath Hematoma. Medscape 2014
• 6 Turan V, Colluoglu C, Turkyilmaz E, Korucuoglu U. Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol 2011; 82 (11) 817-821
• 7 Cunningham GF. Williams Obstetrics. 24th ed. New York: McGraw-Hill Professional; 2014. . Print
• 8 Creasy RK, Resnik R. Maternal-Fetal Medicine Principles and Practice. 7th ed. Philadelphia, PA: Saunders/Elsevier; 2014. . Print
• 9 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 95: anemia in pregnancy. Obstet Gynecol 2008; 112 (1) 201-207
• 10 Schwaiberger D, Karcz M, Menk M, Papadakos PJ, Dantoni SE. Respiratory Failure and Mechanical Ventilation in the Pregnant Patient. Crit Care Clin 2016; 32 (1) 85-95
• 11 Teofili L, Bianchi M, Zanfini BA , et al. Acute lung injury complicating blood transfusion in post-partum hemorrhage: incidence and risk factors. Mediterr J Hematol Infect Dis 2014; 6 (1) e2014069