Abstract
INTRODUCTION AND IMPORTANCE: Rectus sheath hematoma (RSH) is an uncommon but significant cause of acute abdominal pain in pregnancy, challenging in both diagnosis and treatment. It often arises from ruptured epigastric vessels and is associated with factors like anticoagulation therapy and previous abdominal surgery. Misdiagnosis, due to nonspecific symptoms, frequently leads to unnecessary surgeries, posing substantial risks to maternal and fetal health. CASE PRESENTATION: We present a case of a 32-year-old multiparous woman at 31 weeks of gestation, experiencing right-sided abdominal pain and irregular contractions. With a history of four full-term deliveries and no recent trauma, her examination showed hemodynamic stability but featured pain upon movement and a notable blue discoloration in the left abdominal area. Moderate anemia was observed in lab tests. The diagnosis of RSH was confirmed via ultrasound and MRI. The treatment approach shifted from conservative to surgical due to deteriorating symptoms and falling hemoglobin levels. CLINICAL DISCUSSION: This case highlights the rarity and seriousness of RSH in pregnancy. Its non-specific symptoms complicate differential diagnosis, underscoring the need for prompt and precise diagnosis to avoid unwarranted surgical interventions. While conservative management is preferred in stable cases, surgical action is required in situations of instability or hematoma growth. CONCLUSION: RSH is a critical consideration in pregnant patients with acute abdominal pain. Early detection and tailored management are essential to mitigate surgical risks and ensure the safety of mother and child. This case reinforces the importance of vigilant and systematic patient evaluation to improve outcomes and minimize unnecessary surgical procedures.