Hematoma of the Rectus Sheath-Abdominal Muscles, Abdominothoracic Rhythm, and Visceroptosis

Hematoma of the Rectus Sheath

Hematoma of the rectus sheath is uncommon but important, since it is often overlooked. It occurs most often on the right side below the level of the umbilicus. The source of the bleeding is the inferior epigastric vein or, more rarely, the inferior epigastric artery. These vessels may be stretched during a severe bout of coughing or in the later months of pregnancy, which may predispose to the condition. The cause is usually blunt trauma to the abdominal wall, such as a fall or a kick. The symptoms that follow the trauma include midline abdominal pain. An acutely tender mass confined to one rectus sheath is diagnostic

Abdominal Muscles, Abdominothoracic Rhythm, and Visceroptosis

The abdominal muscles contract and relax with respiration, and the abdominal wall conforms to the volume of the abdominal viscera. There is an abdominothoracic rhythm. Normally, during inspiration, when the sternum moves forward and the chest expands, the anterior abdominal wall also moves forward. If, when the chest expands, the anterior abdominal wall remains stationary or contracts inward, it is highly probable that the parietal peritoneum is inflamed and has caused a reflex contraction of the abdominal muscles. The shape of the anterior abdominal wall depends on the tone of its muscles. A middle-aged woman with poor abdominal muscles who has had multiple pregnancies is often incapable of supporting her abdominal viscera. The lower part of the anterior abdominal wall protrudes forward, a condition known as visceroptosis. This should not be confused with an abdominal tumor such as an ovarian cyst or with the excessive accumulation of fat in the fatty layer of the superficial fascia.