The development of an acute abdominal pain and of a palpable mass following a muscular strain, such as after coughing or sneezing, are features higly suggestive of an abdominal wall hematoma in the patient with predisposing factors. The diagnosis is often difficult since the condition mimics the clinical features of other abdominal pathologies. The diagnostic accuracy has significantly improved however after the advent of ultrasonogarphy and of computed tomography. Once the diagnosis is confirmed, the patient should be treated conservatively since surgery entails the risk of various complications.