BACKGROUND:

Rectal sheath hematoma is an infrequent finding that, on multiple occasions, is associated with predisposing factors, such as laparoscopic surgery.

OBJECTIVES:

To define the etiology, possible predisposing factors and related triggers. To approach the most frequent clinical manifestations, the most relevant diagnostic tests and the most appropriate treatments.

CLINICAL CASE:

46-year-old patient, diagnosed with right adnexal cyst, proposed for laparoscopic surgery. Two days postoperatively she presented with acute abdominal pain accompanied by a drop in hemoglobin. Imaging tests showed a large hematoma in the abdominal wall, in the rectus abdominis area, with active bleeding. Surgical treatment allowed identification and ligation of the bleeding vessel and drainage of the hematoma. During the postoperative period the patient evolved favorably and was discharged asymptomatic.

CONCLUSIONS:

Although rectus sheath hematoma is an exceptional clinical finding that usually dissolves with conservative treatment, on some occasions the delay in diagnosis can be life-threatening for the patient. It is a condition that should be kept in mind when establishing the differential diagnosis of acute abdominal pain. This is how an accurate and early diagnosis can be reached, and the most appropriate treatment for each case can be indicated.