TTP8.02 Massive spontaneous idiopathic intrabdominal haemorrhage due to short gastric vessel rupture

Aims/Background Spontaneous intrabdominal haemorrhage, also known as abdominal apoplexy, refers to the severe and potentially life-threatening condition of intraperitoneal haemorrhage of non-traumatic or pathologic origin. Although rare, it represents a life-threatening emergency. Patients usually present with abdominal pain and signs of haemodynamic instability. Rupture of short gastric vessels is an exceedingly rare cause of abdominal apoplexy with only a few reported cases in medical literature. Methods/case presentation We report a case of a 25-year-old male that presented to the emergency department hemodynamically unstable, complaining for a 12-hours-lasting intense abdominal pain. The patient recalled that he experienced episodes of severe vomiting and syncope following heavy alcohol consumption. His medical history was unremarkable with no preceded traumatic injury. Following resuscitation, computer tomography revealed intrabdominal contrast media extravasation. Results He underwent an urgent exploratory laparotomy that revealed massive hemoperitoneum caused by a short gastric vessel tear. The ruptured short gastric vessel was uneventfully suture ligated which successfully controlled the source of bleeding. After an uneventful postoperative course, the patient was discharged on postoperative day 8. Conclusions Severe vomiting associated with acute abdominal pain and hypovolemia, following alcohol consumption in young patients, should raise the suspicion of abdominal apoplexy. Short gastric vessel rupture is an extremely rare cause of abdominal apoplexy. Prompt diagnosis with tomographic imaging and timely exploratory laparotomy succeeding hemostasis with suture ligation of the bleeding vessel may intercept its potentially fatal course.