Introduction: Non-traumatic intramural hematoma in the gastrointestinal tract is a rare event that could have diverse clinical presentation. The small intestine is the site of predilection to this condition. Intestinal obstruction is the main presentation. Various degrees of acute abdominal pain with peritoneal signs would make a cumbersome diagnosis. Case reports: Retrospective review of the surgical emergency admissions database was conducted back to 1994. A literature overview was conducted. Three cases were retrieved and presented in this manuscript. More than 20 reports, with acute abdominal pain as a main presentation, were found in the literature. Discussion: Complete history taking is mandatory not to miss such an uncommon complication. The INR level should be asked for in every case on oral anticoagulant presenting with acute abdominal pain. CT scan is the main diagnostic tool. Conservative management is the standard therapeutic approach.