The case of large rectus abdominis hematoma of a patient affected by chronic obstructive polmunary disease, complicated by respiratory insufficiency, treated with low molecolar weight heparin (LMWH) is described; a spontaneous rectus hematoma is an uncommon condition that is to be considered in patient treated with LMWH at prophylactic dose, even in absence of other predisposing conditions, in the case of acute abdominal pain with evidence of abdominal mass and anemic syndrome.
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