Cough-induced rectus sheath hematoma in a healthy adult male - a case report

Spontaneous rectus sheath hematoma (RSH) is a rare and underdiagnosed condition that can mimic more serious causes of acute abdominal pain leading to unnecessary surgery or delay in management. It occurs due to bleeding within the rectus sheath, often caused by the rupture of epigastric vessels or rectus abdominis muscle.

In the case presented in this study, a 47-year-old man presented with acute left upper quadrant pain and a painful abdominal mass following a severe coughing episode. Imaging confirmed a rectus sheath hematoma. Conservative management, including bed rest and pain relief, led to recovery. At follow-up, the patient was asymptomatic and advised to quit smoking.

Spontaneous rectus sheath hematoma (RSH) is a rare cause of acute abdominal pain, often triggered by coughing, sneezing, or vomiting. Risk factors include hypertension, obesity, and anticoagulant use. This case highlights a RSH in the left upper quadrant, a less common site diagnosed through ultrasound and CT. While most cases are managed conservatively, surgical intervention is necessary in complicated cases.

Rectus sheath hematoma, though uncommon, should be considered in patients presenting with acute abdominal pain and a history of intense coughing even in absence of abdominal trauma or anticoagulant therapy.