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06-08-2008, 08:31 AM
Ä Incidence: Tearing of the inferior epigastric artery occurs in three types of individual:
1. Elderly women, often thin and feeble.
2. Athletic, muscular men, usually below middle age.
3. Pregnant women, mainly multiparas late in pregnancy. As a complication of pregnancy. Surprisingly, the haemorthage into this closed space from this comparatively small artery has proved fatal.
Ä Aetiology: Following a bout of coughing or a sudden blow to the abdominal wall.
ÄClinical features: The possibility of tearing of the epigastric vessels should always be considered when, a severly tender lump appears in relation to the rectus abdominis. The site of the haematoma is usually at the level of the arcuate line, where the posterior sheath of the rectus abdominis is lacking. Occasionally, a haematoma occurs within the muscles lateral to the rectus sheath. Unless there is bruising of the overlying skin, the diagnosis may be difficult.
Ä Differential diagnosis:
1.A twisted ovarian cyst.
2. An appendix abscess when the lump is on the right side.
3. A strangulated Spigelian hernia. It may be difficult but the absence of vomiting suggests a haematoma and the presence of resonance over the swelling favours a Spigelian hernia, while a plain radiograph and C.T. of the abdomen sometimes gives positive evidence of the latter.
Ä Treatment: With rest, a comparatively small haematoma may resolve, but it is safer to operate early, evacuate the clot and ligate the artery.
SOURCE: DR. AYMAN SALEM'S BOOK
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