Background:

Sheath hematoma of the rectus abdominis muscle is a rare cause of abdominal pain. It requires a careful diagnosis, which avoid laparotomy.

Case report:

A 40-year-oldmale playing football, performs an abruptly thoracolumbar hyperextension, presenting immediately a severe and sharp abdominal pain in lower abdomen and inner third of right groin, which made him impossible to continue the activity. Patient required surgery evaluation, finding: signs of local peritoneal irritation with rebound tenderness and involuntary guarding. Abdominal ultrasound showed hematoma in the rectus abdominis sheath type II. It was managed conservatively requiring 60 days to perform abdominal exercises.

Conclusions:

The hematoma rectus sheath, is an uncommon cause of abdominal pain, but should be part of the differential diagnosis of abdominal pain in emergency departments because diagnosis avoids unnecessary laparotomy.