Case 1 :
A 30 year old primigravida complained of a suprapubic lump and difficulty in micturition on the 10th day of a normal vaginal delivery which took place on 7 th May, 2001. On examination her pulse was 84 / min.. blood pressure 140 /90mm of Hg and temperature normal. A suprapubic lump measuring 15 x 10 cm was observed. The overlying skin had a purplish discoloration. Fothergill sign was positive.
Investigations revealed a hemoglobin of 9gm%, total leukocyte count of 7000/ mm' with a normal differential count and the clotting time of 4 minutes.
Ultrasonography disclosed a large amount of fluid collection in the suprapubic region that extended across th e midline. There were clouds of internal echoes at places, suggestive of partial solidification. The fluid collection displaced the urinary bladder downwards and posteriorly, and post-void residual urine was observed.
Case 2:
A 37 year old multipara had a normal vaginal delivery th on 8 July, 2001.On the 4th postpartum day she developed
dysuria and a suprapubic swelling. Her pulse was 90 /
min, blood pressure 130/86 mm of Hg, and temperature
normal. The swelling had a midline cleavage which
su ggested prominent recti. The swelling bulged out more
d istinctly when the patient was asked to tense th e
abdomen (positive Fothergill sign).
The blood profile showed Hb 8.5 gm%, total leukocyte count 10,000 / mm" with a normal differential count and the clotting time of 3 minutes.
On ultrasound examination, a heterogeneous mass was
demonstrated in both re ctus sheaths. The mass was
se p arated in th e midline. Th e urinary bl adder was
displaced posteriorly and downwards.
Instances of rectus sheath hematoma have occurred
during all three stages of child bearing". Occurrence
during labor is readily understood but the observation
that it occurs in puerperium is more difficult to explain'.
The combination of stretched, attenuated muscle and
increased intra-abdominal pressure accentuated by the
straining efforts of labor probably lead to muscle
weakening and fiber disruption'v-'. Rectus sheath
hematoma generally manifests as an acute surgical
abdomen and sudden onset of severe abdominal pain is
the commonest presenting complaint'>. Aspiration
confirms the diagnosis and encou rages conservative
management. Surgery can be avoided.
Both cases were of collection of fresh and congealed blood
in the anterior abdominal wall in the rectus sheath. This
was confirmed by aspiration of brown colored fluid from
the lump. Both hematomas gradually decreased in size
and resolved completely in 8-10weeks. The follow-up
examination revealed nothing abnormal.
