Rectus Sheath Hematoma Causing Intraperitoneal Hemorrhage: An Atypical Emergency Diagnosis

Rectus sheath hematoma (RSH) is a rare but notable cause of abdominal pain, commonly associated with trauma or anticoagulation therapy. It occurs due to the rupture of a branch of the inferior epigastric artery at its attachment to the rectus abdominis muscle, often without effective hemostasis. Diagnosing RSH can be challenging, as it frequently mimics other intra-abdominal conditions. Preoperative identification is uncommon, with most cases diagnosed intraoperatively, and only a limited number of cases reported in the literature. Here, we present the case of a 57-year-old male who developed RSH following blunt trauma to the left lower abdomen caused by a motorbike rim during repair work. The patient reported left lower paraumbilical pain, and intraperitoneal bleeding was confirmed via clinical evaluation and CT imaging. This case highlights the diagnostic complexities of RSH in acute abdominal presentations and emphasizes the importance of thorough examination and imaging for timely diagnosis and management.