The rectus sheath is the aponeurotic envelope encasing the rectus abdominis muscle, formed by the splitting and reunion of the lateral abdominal muscle aponeuroses. Above the arcuate line it has anterior and posterior walls; below the arcuate line all aponeurotic layers pass anteriorly, leaving the posterior wall deficient.
Rectus sheath haematoma is a common emergency presenting as acute abdominal pain, often in anticoagulated patients following coughing or sneezing. Below the arcuate line haematomas can dissect freely into the pelvis. CT is diagnostic. Conservative management suffices for most cases; surgical or angiographic haemostasis is required for expanding haematomas.
Bleeding within the rectus sheath from epigastric vessel rupture or rectus muscle tear, producing acute anterior abdominal pain with a palpable tender mass that does not cross the midline, diagnosed by CT.
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