Rectus sheath hematoma (RSH) is usually a self-limiting uncommon condition seen under belly. It is very rare that the hematomareaches the size of a surgical requirement and that it develops as a result of superior epigastric vessel injury. In this case, wepresented treatment of RSH which caused hypovolemic shock due to superior epigastric vascular injury and treated with ligationof vessels with intraperitoneal sutures via Phannensteil incision. In conclusion, surgery should be considered in patients with ahematoma that is large enough to cause hemodynamic instability or hypovolemic shock. In these patients, treatment with goodcosmetic results can be performed with the same incision with appropriate sutures without forming comorbidity in the patient.