Background: Rectus Sheath Haematoma (RSH) is a well documented but an uncommon entity whose diagnosis could be elusive. It is produced when there is a direct or indirect injury to the rectus muscles and/or epigastric vessels within the rectus sheaths. Spontaneous RSH however has been reported especially in the elderly and infirmed.
Case Report: We report a case of extensive RSH in a 67 year old lady resulting from direct needle trauma
to the inferior epigastric vessels following enoxaparin injection to the anterior abdominal. The
significance of understanding of applied anatomy in clinical practice has been stressed.
Conclusions: The significance of this pathology is its ability to mimic other causes of intra-abdominal acute surgical abdomen presenting a diagnostic dilemma.

Keywords: rectus sheath, haematoma, epigastric vessels, enoxaparin, acute abdomen