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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2019  |  Volume : 30  |  Issue : 6  |  Page : 1488-1489
Spontaneous internal oblique and transverse abdominal muscle hematoma in a patient undergoing peritoneal dialysis


Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University 1-847 Amanumacho, Omiya-ku, Saitama, Saitama, Japan

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Date of Submission15-Mar-2019
Date of Acceptance23-Mar-2019
Date of Web Publication9-Jan-2020
 

How to cite this article:
Matsuyama M, Morino J, Minato S, Kaneko S, Yanai K, Mutsuyoshi Y, Ishii H, Kitano T, Miyazawa H, Aomatsu A, Ueda Y, Ito K, Hirai K, Hoshino T, Ookawara S, Morishita Y. Spontaneous internal oblique and transverse abdominal muscle hematoma in a patient undergoing peritoneal dialysis. Saudi J Kidney Dis Transpl 2019;30:1488-9

How to cite this URL:
Matsuyama M, Morino J, Minato S, Kaneko S, Yanai K, Mutsuyoshi Y, Ishii H, Kitano T, Miyazawa H, Aomatsu A, Ueda Y, Ito K, Hirai K, Hoshino T, Ookawara S, Morishita Y. Spontaneous internal oblique and transverse abdominal muscle hematoma in a patient undergoing peritoneal dialysis. Saudi J Kidney Dis Transpl [serial online] 2019 [cited 2020 Jan 18];30:1488-9. Available from: http://www.sjkdt.org/text.asp?2019/30/6/1488/275500


To the Editor,

Intramuscular hematoma of the abdominal wall is a rare complication in patients undergoing peritoneal dialysis (PD).[1] We herein report a spontaneous internal oblique and transverse abdominal muscle hematoma in a patient undergoing PD. A 52-year-old woman undergoing continuous ambulatory PD (CAPD) was admitted to our nephrology unit because of a one-day history of severe right flank pain. She also had a three-day history of persistent coughing due to acute bronchitis. She had no history of trauma and took no anticoagulant agents. Her PD dialysate was clear without increased cell counts. No PD catheter-related problem was detected. Blood analysis showed anemia (hemoglobin level: 6.5 g/dL). Computed tomography showed a large high-intensity area in the right internal oblique and transverse abdominal muscles [Figure 1]a, thick arrow) and right lower abdominal subdermal fascia [Figure 1]a, thin arrow). The PD catheter tip was located at the pouch of Douglas with no abnormalities. She was diagnosed with an internal oblique and transverse abdominal muscle hematoma. She was conservatively treated with blood transfusion and CAPD. Her abdominal pain subsequently improved, and the hematomas decreased in size [Figure 1]b, thick arrow). She was discharged on admission day 7.
Figure 1: Abdominal computed tomography findings. Internal oblique and transverse abdominal muscle hematoma (Figure1a thick arrow) and right lower abdominal subdermal fascia hematoma (Figure 1a, thin arrow). Seven days later, the hematomas decreased in size (Figure 1b, thick arrow).

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This is the first reported case of a spontaneous internal oblique and transverse abdominal muscle hematoma in a patient undergoing PD. Although previous reports described rectus sheath hematomas in a patient undergoing PD, similar to those in patients without PD, this type of intramuscular hematoma during PD has not been reported.[1],[2] Injury of intramuscular blood vessels caused by excessive strain on the abdominal wall muscle is considered to contribute to intramuscular hematoma formation.[1],[2] In this case, persistent cough and PD fluid may have contributed to the hematoma by increasing the strain on the abdominal wall muscle. Consistent with a previous report of rectus sheath hematoma, our patient’s hematoma gradually decreased with conservative therapy.[2] Clinicians should note this complication when patients undergoing PD complain of abdominal pain. Computed tomography may be useful for diagnosis of this complication.

Conflict of interest: None declared.



 
   References Top

1.
Linhares MM, Lopes Filho GJ, Bruna PC, Ricca AB, Sato NY, Sacalabrini M. Spontaneous hematoma of the rectus abdominis sheath: A review of 177 cases with report of 7 personal cases. Int Surg 1999;84:251-7.  Back to cited text no. 1
    
2.
Balafa O, Koundouris S, Mitsis M, Siamopoulos KC. An unusual case of hemoperitoneum: Spontaneous rectus sheath hematoma. Perit Dial Int 2014;34:134-5.  Back to cited text no. 2
    

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Correspondence Address:
Yoshiyuki Morishita
Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University 1-847 Amanumacho, Omiya-ku, Saitama, Saitama
Japan
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DOI: 10.4103/1319-2442.275500

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