Spontaneous rectus muscle hematoma from inferior epigastric artery hemorrhage

The epigastric arteries are important to consider during several surgical procedures such as trocar placement in laparoscopic surgeries, inguinal hernia repair, paracentesis and drain placements. Bleeding from inferior epigastric artery may result in abdominal wall hematomas that may require surgery. Although trauma is the most common cause for inferior epigastric artery bleeding there have been several cases of spontaneous rupture of an inferior epigastric artery. Predisposing factors may include anticoagulation, hematological disease, previous abdominal operation, injection of drugs and increased intra-abdominal pressure or pregnancy. Ultrasonography (USG) and computed axial tomography with intravenous enhancement is the best diagnostic methods in a hemodynamically stable patient. The treatment can include surgery, endovascular embolization or in selective cases conservative management. We present a case of spontaneous inferior epigastric artery bleeding that required surgery and ligation of the bleeding vessel.