Rectus Sheath Haematoma is a relatively rare presentation in the context of acute Accident and Emergency presentations. Correct diagnosis and subsequent management depend on sound clinical acumen and history taking with appropriate use of diagnostic aides in order to avoid prolonged and inappropriate management of such cases. We present an interesting case of a young fit male whose history alone suggested the diagnosis despite an initial diagnostic dilemma.

CASE REPORT

A fit 18 year old male rugby player presented to Accident and Emergency Department with a 4 hour history of acute onset progressive right lower quadrant abdominal pain. Such pain, described as sharp in nature and exacerbated by pelvic movement and coughing, was initially noticed during a rigorous exercise programme on a rowing machine. He was normotensive, afebrile with a pulse rate of 86 bpm (average).

Examination revealed quite a marked degree of abdominal guarding and rigidity particularly in the right lower quadrant. Nothing else remarkable was in evidence on further examination. Subsequent investigation revealed normal Fbc, Bioprofile, and plain radiographic studies of the abdomen. The patient remained in extremis and treated accordingly …