An unusual cause of acute abdominal pain in dengue fever

Published:January 23, 2014DOI:
      Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).
      TableLaboratory investigations
      Day 1 Day 3 Day 5 Day 7
      Hemoglobin level g/dL 13.2 12 8 7
      White blood cells (mm3) 7500 3500 2100 2200
      Platelets (mm3) 65,000 17,000 9000 12,000
      Hematocrit (%) 39 37 32 35
      Prothrombin time (s) 17 21 27 31
      NS-1 antigen Positive
      PCR for dengue RNA Detected
      Blood glucose (mg/dL) 164 178 210 128
      Serum albumin (g/dL). 2.8 2.3 2.1 3.4
      Abbreviations: NS-1, non structural protein 1; PCR, polymerase chain reaction.
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        • Cherry W.B.
        • Mueller P.S.
        Rectus sheath hematoma. Review of 126 cases at a single institution.
        Medicine. 2006; 85: 105-110
        • Linhares M.M.
        • Lopes Filho G.J.
        • Bruna P.C.
        • et al.
        Spontaneous hematoma of the rectus abdominis sheath: a review of 177 cases with report of 7 personal cases.
        Int Surg. 1999; 84: 251-257
        • Hershfield N.B.
        The abdominal wall. A frequently overlooked source of abdominal pain..
        J Clin Gastroenterol. 1992; 14: 199-202
        • Osinbowale O.
        • Bartholomew J.R.
        Rectus sheath hematoma.
        Vasc Med. 2008; 13: 275-279
        • Thomson H.
        • Francis D.M.
        Abdominal-wall tenderness: a useful sign in the acute abdomen.
        Lancet. 1977; 2: 1053-1054
        • Klingler P.J.
        • Wetscher G.
        • Glaser K.
        • et al.
        Use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders.
        Surg Endosc. 1999; 13: 1129-1134
        • Moreno Gallego A.
        • Aguayo J.L.
        • Flores B.
        • et al.
        Ultrasonography and computed tomography reduce unnecessary surgery in abdominal rectus sheath hematoma.
        Br J Surg. 1997; 84: 1295-1297
        • Rimola J.
        • Perendreu J.
        • Falcó J.
        • et al.
        Percutaneous arterial embolization in the management of rectus sheath hematoma.
        AJR Am J Roentgenol. 2007; 188: W497-W502
        • Berná-Serna J.D.
        • Sánchez-Garre J.
        • Madrigal M.
        • et al.
        Ultrasound therapy in rectus sheath hematoma.
        Phys Ther. 2005; 85: 352-357
        • Siu W.T.
        • Yau K.K.
        • Cheung H.Y.
        • Law B.K.
        • Tang C.N.
        • Yang G.P.
        • et al.
        Spontaneous rectus sheath hematoma.
        Can J Surg. 2003; 46: 390