Rectus sheath hematoma is a rare cause of acute abdominal pain which is often misdiagnosed and leads to unnecessary investigations, surgical referrals and laparotomies. Global warming and international transportation contribute to the increased annual incidence of dengue fever. We presented a 79-year-old male of rectus sheath hematoma presenting with acute abdominal pain, coinciding with dengue virus infection. The particular clinical symptoms, etiologies, differential diagnosis, radiological images and treatment for this condition are presented.