A marriage of inconvenience

A 62-year-old woman presented to the emergency department with a persistent cough and severe abdominal pain. Computed tomography showed the rare condition of a spontaneous rectus sheath haematoma on the right side (Figure A). The patient commented that her husband had been suffering the same symptoms for days, and that he was taking warfarin therapy. Six hours later, he presented to the same hospital with a matching rectus sheath haematoma on the left side (Figure B), and required blood transfusion. This completed a “marriage of inconvenience”, but did bring them closer to marital bliss — they shared a room in hospital, although in separate beds!

Spontaneous rectus sheath haematoma is very rare. Coughing can rub the inferior epigastric artery or its perforating branches against the free posterior edge of the rectus sheath. Clinical suspicion should be raised in the elderly patient taking anticoagulant therapy. To our knowledge, this is the first reported case of simultaneous presentation of rectus sheath haematoma in family members.

Computed tomography scans of matching rectus sheath haematomas in a married couple.