Rectus Sheath Haematoma Mimicking An Ovarian Mass

摘要

Rectus sheath haematoma (RSH) is an unusual cause of a painful abdominal mass. We report a case of rectus sheath haematoma that was referred to KK Women's and Children's Hospital, Singapore because initial radiological investigations suggested an ovarian tumour. Case Report A 41year old woman, para 3, presented to her general practitioner complaining of left iliac fossa pain for 2 weeks. There was no history of trauma, nausea, vomiting, fever or chills. Co-incidentally, she developed a cough 2 weeks before her presentation. There was no other significant medical history of note. Pelvic ultrasound showed an elongated tubular structure measuring 8cm by 3cm located in the left adnexa anteriorly. It was cystic with non-specific internal echoes with slight thickening of the wall at some parts. The impression was of an ovarian cyst containing some non-specific internal echoes or a hydrosalpinx. She was referred to KK Women's and Children's Hospital for further management.Physical examination revealed a vague mass over the left iliac fossa with slight skin discoloration over the area. Bimanual vaginal examination demonstrated an 8cm left adnexal mass, which was slightly tender. Ovarian tumour markers performed were within normal limits: Ca125 5.5 U/ml, HCG <2 IU/L, FP 4.1 ug/L and CEA <0.5 ug/L. Her haemoglobin was 11.1 g/dl and total white count was 7.57x109/L. A repeat pelvic ultrasound scan showed a left adnexal cystic tubular structure measuring 5.6 by 4.4 by 2.6cm (Fig. 1). The left ovary could not be visualized and the right ovary and uterus were normal. The impression was that of a left ovarian cyst or hydrosalpinx.