Abdominal apoplexy: rupture of short gastric artery after retching

Theiyallen Ambikapathi and Sentilnathan Subramaniam and Mohd Firdaus Mohd Hayati (2022) Abdominal apoplexy: rupture of short gastric artery after retching. Annals of African Surgery, 19. pp. 54-57. ISSN 1999-9674 (P-ISSN) , 2523-0816 (E-ISSN)

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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.

Item Type: Article
Keyword: Intraperitoneal hemorrhage , Abdominal apoplexy , Acute abdomen , Short gastric artery , Hemoperitoneum
Subjects: R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC254-282 Neoplasms. Tumors. Oncology Including cancer and carcinogens
Department: FACULTY > Faculty of Medicine and Health Sciences
Depositing User: SAFRUDIN BIN DARUN -
Date Deposited: 28 Jul 2022 08:05
Last Modified: 28 Jul 2022 08:05
URI: https://eprints.ums.edu.my/id/eprint/28945

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