Snapshot quiz 12/11

Published: 07/03/2012

Authors: Harris AR, McKevitt G and Neill A

A young woman presented with 24 h of abdominal pain. Examination revealed right iliac fossa peritonism. Urine and pregnancy tests were negative. White cell count was 15·4 × 109 cells/l. Laparoscopy revealed a red swelling arising pre-peritoneally with bruising across the pelvis. Full laparoscopy revealed a normal appendix and pelvic organs but an inferior rectus sheath haematoma which had ruptured inferior to the arcuate line. Due to symptoms, the anterior sheath was opened, the clot evacuated, haemostasis achieved and the wound closed over a drain. The patient was discharged without a drain after 48 h. Repeat ultrasound after four months confirmed resolution.