Background: Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed as intra-abdominal pathologies. Elderly individuals and those on anticoagulation are more prone. Rectus sheath hematomas are more common as compared to internal oblique hematomas, which are rare. Case Report: We are reporting a rare case of internal oblique hematoma confirmed with contrast enhanced computed tomographic images. The patient was a 60 year old lady, with history of recurrent bouts of cough for one month. She had noticed a sudden onset swelling in the right flank over three day duration. Conclusion: In the emergency medicine department sharp clinical skills and early diagnosis of an anterior abdominal wall hematomacould prevent delay in management of such rare conditions. Internal oblique muscle hematoma should be considered as a differential diagnosis of a lateral abdominal swelling, especially in elderly and those on anticoagulation.

Keywords: Abdominal Pain; Anterior Abdominal Wall Muscle; Rectus Sheath; Internal Oblique Muscle; Hematoma.