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Case 89: 'Peritonitis'

This patient had been in hospital for 5 days with an exacerbation of chronic bronchitis. You are called to the medical ward because the respiratory doctors have found their patient to have developed abdominal pain overnight, and a tender lump in the left upper quadrant of his abdomen. You take a history from the patient and examine him. You suspect the diagnosis, and confirm it with a scan.

1. What is the diagnosis?

Left sided rectus sheath haematoma

2. What are the risk factors?

Repetitive coughing
prior history of rectus sheath haematoma (which this patient had)
prior history of abdominal surgery - see the subcutaneous metallic clip from hernia surgery

3. What are the risks now for the patient?

Exanguination if the bleeding is ongoing
Pain which may limit respiratory state.

Further Reading
Rectus sheath haematoma: a new set of diagnostic features