Portable Percussive Massage Device-Related Rectus Sheath Hematoma and Obstructive Uropathy

The case report by Lawrence Kwon from Nephrology, Westchester Medical Center, Poughkeepsie, NY, USA. published in Biomedicine Hub discusses a unique instance of rectus sheath hematoma leading to acute ureteral obstruction.

This occurred in a morbidly obese man in his late 50s, who was admitted with severe complications from COVID-19, including acute respiratory syndrome, bilateral peroneal deep vein thromboses, and acute kidney injury. The patient was treated with anticoagulants (enoxaparin and apixaban), dexamethasone, and remdesivir. He experienced severe abdominal pain, leading to the identification of a large right rectus sheath and extraperitoneal pelvic hematoma via tomography. The hematoma extended across the midline into the left pelvis and retroperitoneum, causing mild right hydronephrosis.

The hematoma was linked to the use of a handheld deep-tissue percussive massage device applied repeatedly at the site of enoxaparin injection in an attempt to relieve pain. On day 12, bilateral nephrostomy tubes were inserted, and a nephrostogram revealed mild hydroureteronephrosis and extrinsic compression of the bladder. The patient suffered a cardiac arrest and died on day 17.

This case highlights the importance of considering uncommon causes of obstructive uropathy in diagnosing and managing acute kidney injury, especially in hospitalized patients on anticoagulation therapy.

This is the first reported instance of obstructive uropathy caused by a retroperitoneal hematoma associated with the use of a portable massage device applied to the abdominal wall.