The inferior and superior epigastric arteries lie deep to, or within, the rectus abdominal muscles. If these muscles contract suddenly then the epigastric arteries may be torn. The haematoma that develops within the muscle causes pain and swelling.
Although it is usual to conclude that haematomata in the rectus sheath arise from tears of the epigastric arteries, they may also be caused by tears of the muscle fibres with damage to the very small nutrient vessels.
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