Rectus sheath hematoma is an uncommon problem caused by the acute disruption of epigastric vessels or rupture of a rectus muscle that can clinically mimic an acute surgical abdomen. Although this entity usually is self-limiting and can be managed conservatively, bleeding into the rectus muscle in an anticoagulated patient is potentially life threatening. We report a case of a 21-year-old female student who presented with an acute onset of abdominal pain after physical fitness training.