Background: Rectus sheath hematoma (RSH) is an acute or chronic collection of blood in the sheath of the rectus abdominis caused by disruption of epigastric vessels or muscle tear. It is an uncommon cause of painful abdominal mass that often mimic acute abdomen, which may lead to unnecessary surgical interventions. We report a case of a rectus sheath hematoma precipitated by vigorous cough attacks in an elder woman. Discussion focuses on imaging findings and treatment modalities of RSH in view of recent literature.
Case Report: A 67-year-old woman who had complaints of acute abdominal pain, nausea and vomiting presented in our emergency department (ED) following severe cough attacks. Rectus sheath hematoma was diagnosed by abdominal ultrasound (US) and computerized tomography (CT). The patient recovered uneventfully with bed rest, parenteral electrolyte solutions and narcotic analgesic treatment.
Conclusions: RSH should be considered in the differential diagnosis of painfull abdominal masses in elder inviduals, especially those suffering from severe cough attacks or receiving treatment with anticoagulants. The diagnosis of RSH can be made clinically and via US findings. CT of the abdomen should be performed for definitive diagnosis, and the principle therapy is conservative management.

Keywords: computerized tomography (CT), conservative management, painful abdominal mass, rectus sheath hematoma, cough attacks