Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding — A case report

INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed two days after a fall. A sigmoidoscopy revealed that the source of bleeding was a presacral hematoma penetrating into the rectum. A Computed Tomography scan of the pelvis confirmed the presence of a hematoma measuring 10 × 9.4 cm in the presacral space, as well as a fracture of os coccygis. She was transferred to a highly specialized facility, where she was treated conservatively with blood transfusions and repeated endoscopic toilet of the presacral cavity. One month after her initial fall, the patient had fully recovered. DISCUSSION: Rectal bleeding usually causes suspicion of a bleeding in the gastrointestinal tract. In this report the patient’s anticoagulant treatment has likely contributed to bleeding and the formation of the hematoma. To our knowledge, this is the first case report of a presacral hematoma acutely penetrating into the rectum and causing lower gastrointestinal bleeding. CONCLUSION: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities.