Rupture of the epigastric artery with hematoma formation in the rectus sheath is an uncommon condition which can mimic serious intraabdominal disorders. Treatment is primarily conservative, but misdiagnosis can lead to unnecessary surgery. However, the correct clinical diagnosis should be suggested by the presence of paroxysmal cough, anticoagulant therapy, or trauma, the precipitating factors found in most cases. Ultrasonography and CT scan are excellent diagnostic modalities in this condition. 3 unoperated cases in which the correct diagnosis was made are presented. Despite its benign nature this condition may be fatal. Awareness and vigorous supportive therapy are therefore recommended to reduce morbidity and mortality.