Bhasyani Nagaretnam

Department of Emergency and Trauma, Hospital Sungai Buloh, Jalan Hospital, Petaling, Selangor, Malaysia

Keywords: Anemia, emergency department, intubated, prone position, rectus sheath hematoma


Rectus sheath hematoma (RSH) is a life threatening condition. Its pathology lies behind its unique anatomy. Critically ill COVID 19 patients are managed in the emergency department for longer periods while awaiting critical care admission. Therefore, more complex procedures such as prone positioning are performed in the emergency department to ensure patient care continues. We report this case of RSH in an intubated critically ill COVID 19 patient requiring prone position. During her stay in the Emergency Department Acute Care Unit, she developed anemia, uremia, and worsening hypoxia. Emergency contrast enhanced computed tomography leads to our diagnosis of RSH. She was treated with a conservative approach and blood transfusion. We would like to highlight this case for its diagnostic complexity since this ventilated patient required both biochemical and radiological markers to diagnose RSH in combination with high suspicion levels. RSH must be considered in patients with risk factors such as prone position and anticoagulant usage. Last, a holistic approach to critically ill patients will not only benefit patients but also health care profession. The direction of care should be decided based on the patient’s condition, imaging, and hospital resources.