Sonographic demonstration of a spontaneous rectus sheath hematoma following a sneeze: a case report and review of the literature.

Spontaneous rectus sheath hematoma (SRSH) is an uncommon cause of acute abdominal pain characterized by bleeding within the rectus sheath; it is a benign condition and, in most cases, it is treated conservatively. Bleeding of the abdominal wall is an unusual condition that is quite challenging to identify promptly and can be easily overlooked during a routine physical examination. In daily practice, anticoagulant therapy is one of the main risk factors for hemorrhagic events. In this respect, we report a rare case of spontaneous hematoma of the abdominal wall (diagnosed and monitored through an ultrasound examination) that arose after sneezing in a patient receiving anticoagulant treatment.

[Acute gastroduodenal lesions and stress]. / Lesioni gastroduodenali acute e stress.

Haemorrhagic gastroduodenitis together with complicated peptic ulcer, are--after trauma--the most common causes of urgent admission in hospital for young people. In the present paper the Authors deal with the role of emotional disturbances, generated by environmental stress, in the pathogenesis of many gastrointestinal diseases in the young. They observed a rise in the incidence of gastroduodenal pathology (especially of the erosive-haemorrhagic form) in young males during military service. So they hypothesized that such high incidence of acute GDD during military service, could be attributed to abrupt changes in lifestyle, generating a significant environmental stress. The results of a clinical study on 65 young conscripts out of 483 who underwent EGDS for acute digestive symptoms also tested for psychological evaluation to stress response, are reported. In the 60.7% of all patients, MMPI (Minnesota Multiphasic Personality Inventory) test showed pathological alterations. Correlating the pathological findings with MMPI results, the Authors found that the 25% of patients suffering from oesophagitis, the 36.3% of those with peptic ulcers, the 68% of aspecific gastroduodenitis and the 75% of erosive-haemorrhagic gastroduodenitis, had psychological disturbances. The study shows that GDD in the young is a very frequent pathology, which may be triggered off by abrupt changes in life style, especially in those patients who are unable to react positively to changes in the outer world. GD pathology arises most frequently during the first five months of military service, especially within the third and the fourth month. The Authors conclude that a correct management of GDD in the young needs a versatile approach based on EGDS to establish the correct diagnosis, and on psychopathological investigations.