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Case 3: Right sided abdominal pain

This 77 year old man with a prosthetic mitral valve presented complaining of right sided abdominal pain.

1. What has happened to cause the pain?.

Right sided rectus sheath haematoma. This patient will most likely be fully anticoagulated because of his heart valve. A spontaneous haemorrhage like this is uncommon but can be difficult to treat.

2. Treatment?

Observation in ICU, resuscitation, transfusion, correction of anticoagulation, analgesia and occasionally angiography and embolisation.

3. What is the subcutaneous mass in the anterior abdominal wall?

Paraumbilical hernia, probably unrelated.