Rectus sheath hematoma is a rare but well-known cause of acute abdominal pain. Rectus sheath hematoma is largely misdiagnosed as seen rarely. As a fatal disorder it must be suspected especially in patients receiving anticoagulant therapy for any reason. Heparin exposure during hemodialysis sessions and uremic bleeding diathesis causes chronic hemodialysis patients to be vulnerable to rectus sheath hematoma. Rectus sheath hematoma may be mild and self-limiting but also be so severe that it threatens life because of hypotensive shock and anemia-related risks. The patient may present without symptoms, with abdominal pain or with hemodynamic shock. We present a case report describing a patient with recurrent abdominal pain due to rectus sheath hematoma exacerbating after hemodialysis sessions.