DOI: https://doi.org/10.36347/sasjs.2026.v12i01.020

Pages: 120-123

Background: Rectus sheath hematoma [RSH] is an uncommon cause of acute abdominal pain and represents a diagnostic challenge during pregnancy because of its nonspecific presentation and resemblance to obstetric and surgical emergencies. Delayed recognition may lead to inappropriate interventions and increased maternal–fetal morbidity. Case presentation: We report the case of a 41-year-old multiparous woman at 30 weeks of gestation with no history of trauma or anticoagulant therapy who presented with sudden-onset severe right flank pain. Initial clinical, biological, and obstetric evaluations were unremarkable, with reassuring fetal assessment and absence of inflammatory syndrome. Despite symptomatic treatment, the patient’s condition worsened after 48 hours, with vomiting and increasing pain. Imaging revealed an extrauterine heterogeneous mass, and magnetic resonance imaging confirmed a rectus sheath hematoma. A rapid decline in hemoglobin from 12 g/dL to 6 g/dL indicated active bleeding and prompted urgent surgical intervention. Intraoperative findings showed a large hematoma within the right rectus sheath with bleeding from inferior epigastric vessel branches, which were successfully ligated. Postoperative recovery was favorable after blood transfusion. The pregnancy subsequently progressed without complications, and a healthy neonate was delivered by elective cesarean section at 39 weeks of gestation. Conclusion: Spontaneous rectus sheath hematoma should be considered in pregnant patients presenting with acute abdominal pain when obstetric evaluation is reassuring, particularly in the presence of unexplained anemia. Early use of appropriate imaging and individualized management are crucial to avoid diagnostic delay and ensure favorable maternal and fetal outcomes.