Abstract / Summary
Abstract Background Rectus sheath hematoma (RSH) is a potentially fatal complication typically associated with antithrombotic therapy, advanced chronic kidney disease (CKD), and abdominal wall strain. Patients with autosomal dominant polycystic kidney disease (ADPKD) often share these established risk factors; however, whether ADPKD-related abdominal wall stretching and increased intra-abdominal pressure confer additional mechanical vulnerability to RSH remains unclear. Moreover, RSH presentation mimics typical cyst-related complications, potentially causing diagnostic delays. Methods We conducted a retrospective observational case series evaluating patients with ADPKD diagnosed with RSH between 2003 and 2025 at a major referral center. Among the hospitalized ADPKD cohort, four patients developed RSH. Given the extremely limited sample size, descriptive statistics were utilized without formal hypothesis testing. Results All patients presented with advanced CKD (three requiring hemodialysis) and were receiving antithrombotic therapy. Severe coughing triggered RSH in three cases. Clinically, all patients exhibited acute abdominal pain, progressive anemia, and elevated C-reactive protein levels. Notably, owing to these trying clinical courses, cyst infection or hemorrhage was initially suspected in two cases. Unenhanced computed tomography definitively confirmed RSH in all patients. Although two patients required blood transfusions, RSH was controlled without surgical or endovascular intervention in all four patients. One patient subsequently died from an unrelated perforated gastric ulcer. Conclusions This case series highlights that in patients with ADPKD with established bleeding risks, ADPKD-related abdominal wall stretching and increased intra-abdominal pressure might contribute as a potential additional structural vulnerability to RSH. Because RSH symptoms strongly overlap with ADPKD-specific acute complications, clinicians may consider RSH in the differential diagnosis of acute abdomen in this population to ensure prompt radiological diagnosis.