Fatal rectus sheath hematoma: a rare autopsy phenomenon

• Main Authors: Akma Nurain Fairuz Mahamad Arif, Sharifah Safoorah Syed Alwee Al’Aidrus
• Format: Article
• Language: English
• Published: SpringerOpen 2021-09-01
• Series: Egyptian Journal of Forensic Sciences
• Subjects: Autopsy, Rectus sheath hematoma, Abdominal wall hemorrhage, Forensic
• Online Access: https://doi.org/10.1186/s41935-021-00237-3

Abstract Background Rectus sheath hematoma is a condition where blood is accumulated within the sheath of the rectus abdominis muscle. It is caused by the rupture of either the superior or inferior epigastric artery or from a direct tear of the rectus muscle itself. This condition is usually self-limiting and most of the time, the hematoma is small, non-expanding and can be reabsorbed spontaneously over time. However, certain underlying pathology may lead to the expansion of the hematoma or even a recurrence, and without any medical treatment or intervention, this condition can even be fatal. Due to its rarity, only a few published cases of fatality associated with rectus sheath hematoma are reported worldwide. Case presentation We present a case of non-traumatic fatal rectus sheath hematoma in the presence of underlying lung infection. The deceased complained of abdominal pain 2 days prior to death with a history of prolonged cough. The autopsy revealed the presence of a hematoma within the rectus sheath of the left lower quadrant of the abdomen extending down into the left pelvis and a multitude of small yellow-tan firm lesions scattered throughout the parenchyma of the right lung, suggestive of a lung infection which was later confirmed histologically. Conclusions The case serves to increase awareness of fatal rectus sheath hematoma as a cause of death given its rarity in forensic medicine practice. The importance of a thorough post-mortem examination is the key to noticing the fatal hematoma since its enclosed location within the rectus sheath may be obscured to the eye of an inexperienced prosector.