Embolization of Inferior Epigastric Artery for Treatment of Rectus Sheath Hematoma Caused by Insulin Injection During Anticoagulation and Antiplatelet Therapy

Abstract

Rectus sheath hematoma is uncommon cause of abdomi- nal pain1-3). It is caused by rupture of epigastric vessel or muscle tear. Cases of rectus sheath hematoma are most fre- quently encountered in association with anticoagulation the- rapy, trauma, operation, and hematologic disorder. It rarely happens spontaneously1-6). Most patients can be successfully treated with supportive care (intravenous fluids, pain manage- ment) with or without blood transfusion. Fewer patients had reversal of anticoagulation, endovascular embolization of suspect vessels, or surgery for rectus sheath hematoma1). In special medical condition such as high risk of continuous bleeding on anticoagulation and antiplatelet therapy, more invasive therapies with embolization of the bleeding vessel or surgery can be first line management. We report a case of percutaneous, catheter-based coil embolization for treat- ment of rectus sheath hematoma caused by subcutaneous injection of insulin on abdomen during anticoagulation and antiplatelet therapy in an 83-year-old thin woman with diabetes.