48-year-old woman develops pain in the right lower quadrant

Discussion in 'MRCS Forum' started by Like., Apr 5, 2008.

  1. Like.

    Like. Guest

    A 48-year-old woman develops pain in the right lower quadrant while playing tennis. The pain progresses and the patient presents to the emergency room later that day with a low-grade fever, a white blood count of 13,000, and complaints of anorexia and nausea as well as persistent, sharp pain of the right lower quadrant. On examination, she is tender in the right lower quadrant with muscular spasm and there is a suggestion of a mass effect. An ultrasound is ordered and shows an apparent mass in the abdominal wall. Which of the following is the most likely diagnosis?
    a- Acute appendicitis
    b- Cecal carcinoma
    c- Hematoma of the rectus sheath
    d- Torsion of an ovarian cyst
    e- Cholecystitis
  2. Like.

    Like. Guest

    Answer: c. (Greenfield, 2/e, pp 1236) Hematomas of the rectus sheath are more common in women and present most often in the fifth decade. A history of trauma, sudden muscular exertion, or anticoagulation can usually be elicited. The pain is of sudden onset and is sharp in nature. The hematoma is most common in the right lower quadrant, and irritation of the peritoneum leads to fever, leukocytosis, anorexia, and nausea. The diagnosis can be established preoperatively with an ultrasound or CT scan showing a mass within the rectus sheath. Management is conservative unless symptoms are severe and bleeding persists, in which case surgical evacuation of the hematoma and ligation of bleeding vessels is required.

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