How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Background: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anti-coagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up.

Methods: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups.

Results: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group.

Conclusion: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.