Abstract
Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature. A 30-year-old woman presented with acute abdominal pain and breathlessness and was in class II hypovolemic shock. She had a history of multiple episodes of retching with non-bilious vomiting prior to that. Computed tomography (CT) reported a non-rotation of the gut, gross intraperitoneal free fluid with debris, and possible perforated appendicitis. Laparoscopy revealed a gross hemoperitoneum of 2.5 L, with bowel findings consistent with non-rotation of the gut, but technical difficulty in identifying the source of bleeding led to conversion to laparotomy. A ruptured short gastric artery was ascertained to be the source of bleeding and was successfully ligated. A retrospective review of the preoperative CT showed intraperitoneal free fluid with Hounsfield unit measurements of 48 and 52, suggestive of acute hemoperitoneum. ISIH is often a delayed diagnosis or missed diagnosis due to its low incidence. The presence of vomiting and abdominal pain with hypovolemic shock, especially in a young individual, should raise the suspicion of ISIH, which can be confirmed via early CT imaging to facilitate achieving hemostasis during surgery.
Highlights
Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature
ISIH was first reported by Barber in 1909, as he described a case of a pregnant woman who had intraperitoneal hemorrhage in the absence of trauma or surgery and the source of bleeding could not be identified [1]
We report a case of 30-yearold lady with a significant history of retching who presented with abdominal pain and hypovolemic shock that turned out to be ISIH secondary to a ruptured short gastric artery
Summary
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature. ISIH was first reported by Barber in 1909, as he described a case of a pregnant woman who had intraperitoneal hemorrhage in the absence of trauma or surgery and the source of bleeding could not be identified [1]. A total of 110 cases of ISIH have been reported between 1909 and 1998 by Carmeci et al [2]. In their series, a preponderance to the male sex (male/female ratio: 3:2) and the fifth and sixth decades of life were noted [2]
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