Rectus sheath hematoma masquerading as acute pancreatitis: a case report

Introduction and Importance: Rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain that may mimic more serious intra-abdominal emergencies, including acute pancreatitis. Case Presentation: We present the case of a 62-year-old man who developed a large RSH following a coughing episode, presenting with right-sided abdominal pain and periumbilical ecchymosis (Cullen's sign). Normal pancreatic enzymes and computed tomography (CT) imaging were key in excluding pancreatitis and confirming the diagnosis of RSH. The patient was managed conservatively with a successful resolution. Clinical Discussion: This case highlights the importance of considering RSH in the differential diagnosis of acute abdomen, even in the absence of anticoagulation, and the critical role of imaging in its timely diagnosis. This case reinforces the value of CT imaging and focused physical examination in differentiating RSH from other causes of acute abdomen. Conclusion: RSH remains a rare but critical diagnostic consideration in patients presenting with acute abdominal pain, particularly when Cullen's or Grey Turner's signs are present but pancreatic enzymes are normal. Early diagnosis, facilitated by CT imaging, can prevent unnecessary surgical interventions and guide successful conservative management, thereby improving patient outcomes.