Spontaneous Hematoma of the Left Abdominal Wall Secondary to Costal Exostosis: A Case Report

A case of spontaneous left abdominal wall hematoma is presented in a 50-year-old male patient with a history of recently diagnosed hypertension under treatment, morbid obesity for the past 10 years without nutritional management, and occasional smoking and alcohol consumption. The patient presented with oppressive epigastric pain following food intake, accompanied by coughing and diaphoresis, with an initial intensity of 8/10 progressing to 10/10, radiating to the thoracic region. Upon admission, he exhibited a hypertensive emergency and signs of angina, requiring stabilization with nitroglycerin and management in the shock unit. During evaluation, a hematoma in the left abdominal wall was identified, along with a fracture of the left eighth costal arch and a costal exostosis on the left tenth costal arch, as well as pleural effusion and ipsilateral atelectasis, confirmed by computed tomography (CT). There was no history of trauma, transfusions, or prior surgery. The patient received conservative treatment, including triple antihypertensive therapy (calcium channel blocker, angiotensin II receptor blocker, and prazosin), anti-inflammatory agents, analgesics, and bed rest, without the need for surgical intervention. Acute-on-chronic kidney disease (KDIGO 1) was diagnosed, and the patient was evaluated by cardiothoracic surgery for follow-up.