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Case Reports: Learning from unexpected outcome (positive or negative)
Trauma in the elderly: a bilateral rectus sheath haematoma
  1. Michael McArdle1,2
  1. 1University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
  2. 2South Warwickshire University NHS Foundation Trust, Warwick, UK
  1. Correspondence to Dr Michael McArdle; michaelmcardle1991{at}gmail.com

Abstract

Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.

Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.

This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.

  • Trauma
  • Radiology
  • Interventional radiology
  • General surgery
  • Ultrasonography

https://doi.org/10.1136/bcr-2023-256061

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    Footnotes

    • Contributors The following author was responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: MM. The following author gave the final approval of the manuscript: MM. Author MM is sole contributor with no external input or assistance. Local permission was granted for the creation and submission of this case.

    • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.