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A case is reported of a rectus sheath hematoma occurring as an early consequence of percutaneous endoscopic gastrostomy with hemodynamic compromise. The most likely etiology is damage to the superior epigastric artery intraoperatively. Nonsurgical methods were used to achieve hemodynamic stability. This case illustrates an uncommon complication of gastrostomy tube placement that should be considered early postoperatively for patients with hemodynamic compromise.