Introduction:

Spontaneous abdominal wall hematoma is a rare clinical entity in medical practice. In the context of COVID-19, intra-abdominal hematoma presented as a complication of the imposed therapy and was not taken into consideration when making the differential diagnosis of abdominal pain and arterial hypotension.

Objective:

To report the appearance of rectus abdominis sheath hematoma as a complication of the use of anticoagulants in the course of COVID-19 treatment.

Clinical case:

A 71-year-old patient with COVID-19 is presented who was receiving anticoagulant treatment and began with acute abdominal pain, with abdominal ultrasound that was inconclusive, laparotomy was performed and a large hematoma was found in the abdominal Retzius space. She evolved favourably and is discharged after 7 days.

Conclusions:

The trans-operative diagnosis together with the drainage of the hematoma and the opportune fluid therapy allowed a favourable evolution and the recovery of the patient.

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