An abdominal hematoma is a localized collection of blood outside of blood vessels, specifically within the abdominal cavity or abdominal wall. This condition arises when blood leaks from damaged blood vessels, forming a pool or clot in tissues.
Understanding Abdominal Hematomas
An abdominal hematoma involves blood accumulating in an extravascular space within the abdominal region. This can occur inside the abdominal cavity, affecting organs like the liver or spleen, or within the abdominal wall muscles. A common type is the rectus sheath hematoma, which forms within the rectus abdominis muscle layers. These collections can range in size and sometimes spread beyond the initial bleeding site.
Direct Causes of Abdominal Hematomas
Abdominal hematomas stem from various direct causes, primarily involving injury to blood vessels or impaired blood clotting.
Traumatic injuries are a frequent cause of abdominal hematomas. Blunt force trauma, such as car accidents, falls, or direct blows, can damage internal organs and blood vessels. Penetrating injuries, including stab or gunshot wounds, directly breach tissues and vessels, allowing blood to escape and collect. Even minor trauma or muscle strains can result in bleeding within the rectus sheath.
Medical procedures can inadvertently lead to abdominal hematomas. Abdominal surgeries, biopsies, angiograms, and catheterizations involve instruments that can nick or puncture blood vessels. Procedures like paracentesis or subcutaneous injections can also cause vessel damage.
Anticoagulant medications significantly increase the likelihood of bleeding, even from minor trauma or spontaneously. Drugs like warfarin, heparin, and direct oral anticoagulants thin the blood, making it harder for clots to form. This increased bleeding tendency means even a small vessel injury can result in a substantial hematoma. The incidence of abdominal wall hematomas has notably risen with their widespread use.
Underlying medical conditions can predispose individuals to abdominal hematomas. Vascular abnormalities, such as aneurysms or arteriovenous malformations, can rupture, causing internal bleeding. Bleeding disorders like hemophilia or von Willebrand disease, along with severe thrombocytopenia, impair the blood’s ability to clot, increasing bleeding risk.
Certain infections or inflammatory conditions can weaken blood vessel walls, making them more prone to rupture. Tumors within the abdomen can also bleed spontaneously or after minor trauma. Conditions causing increased intra-abdominal pressure, such as severe coughing, persistent vomiting, or strenuous straining, can lead to vessel rupture.
Abdominal hematomas can also occur spontaneously, often due to an underlying, undiagnosed medical condition or predisposition like severe coagulopathy or weakened vessels.
Factors That Increase Risk
Several factors can increase an individual’s susceptibility to developing an abdominal hematoma.
Age plays a role, with older adults generally more susceptible due to increased fragility of blood vessels and a higher likelihood of falls.
Pre-existing medical conditions can heighten the risk. Severe liver disease impairs the production of clotting factors, making individuals more prone to bleeding. Kidney disease, severe hypertension, and alcoholism can also contribute to vascular fragility or increased bleeding risk.
Certain medications can elevate the risk of hematoma formation. Non-steroidal anti-inflammatory drugs (NSAIDs) can interfere with platelet function, increasing bleeding risk, especially when combined with blood thinners. Corticosteroid use has also been associated with an increased risk.
Prior abdominal surgery can alter anatomy, potentially making subsequent trauma or medical procedures riskier. Pregnancy is also a risk factor for abdominal wall hematomas. Malnutrition or deficiencies in certain vitamins, such as Vitamin K, can impair the blood clotting process, increasing bleeding risk.
Recognizing When to Seek Care
Recognizing the signs and symptoms of an abdominal hematoma is important for prompt medical evaluation.
Common symptoms include abdominal pain, which can vary in intensity and may be localized or widespread. Swelling or a palpable mass in the abdomen may also be present. Bruising on the skin, sometimes appearing around the navel or on the sides, can indicate internal bleeding.
Signs of more significant internal bleeding may include dizziness, lightheadedness, or feeling faint due to blood loss. A rapid heart rate (tachycardia) and low blood pressure (hypotension) are also indicators of internal bleeding. Other symptoms can include nausea, vomiting, or pallor. Any sudden, severe abdominal pain, particularly if associated with trauma or other concerning symptoms, warrants immediate medical attention.