BACKGROUND: A rectus sheath haematoma is a difficult condition to diagnoseand is usually treated by conservative measures. However, significant sized haematomas can result insevere haemodynamic repercussions, especially in those patients with co-morbidities and anticoagulation.CASE REPORT: The case reported here is of a 68 year old anticoagulated patient with severe medical co-morbiditywho presented with abdominal pain and hypotension. An abdominal CT scan demonstrated a large rectus sheathhaematoma and small bowel infarction. The relationship between these two separate causes of an acuteabdomen is discussed and imaging findings are illustrated. CONCLUSIONS: A careful history and a highindex of suspicion are necessary to diagnose a rectus sheath haematoma. Further imaging such as CT maybe required and if diagnosed early enough, it should be treated aggressively based on the clinical findings.

Keywords: Hematoma - radiography, Intestine, Small - radiography, Ischemia - radiography, Muscular Diseases - radiography, Rectus Abdominis - radiography, Tomography, X-Ray Computed