Idiopathic Spontaneous Intraperitoneal Hemorrhage due to Rupture of Short Gastric Artery Presenting as Massive Gastrointestinal Bleeding: A Rare Case Presentation and Literature Review

Idiopathic Spontaneous Intraperitoneal Haemorrhage (ISIH): A Diagnostic Dilemma and Its Conservative Management

Idiopathic spontaneous intraperitoneal haemorrhage (ISIH) is a rare cause of acute abdominal pain. It refers to haemoperitoneum resulting from the rupture of an intra-abdominal vessel without the preceding trauma or underlying pathology. Here, we present the case of a 17-year-old boy with acute abdominal pain. Initially, acute appendicitis was the primary differential diagnosis. Imaging demonstrated a significant volume of intra-abdominal fluid that was haemorrhagic in nature, but no active bleeding or source was identified. A conservative management approach was adopted due to the patient's clinical improvement during his admission. This case highlights the high index of clinical suspicion required to diagnose and investigate ISIH. In contrast to the historical opinion that stipulates management with a surgical intervention, this case demonstrates the possibility of conservative management in stable patients.

Point-of-care ultrasound-assisted diagnosis of gastric vessel rupture in a young man presenting with chest pain: A cautionary tale

We report a young male patient who presented with chest and shoulder tip pain with spontaneous intraperitoneal haemorrhage (haemoperitoneum) due to gastric vessel rupture. Point-of-care ultrasound detected abdominal free fluid, which led to a CT scan of the abdomen and reached the diagnosis. Intra-abdominal bleeding can present as referred chest or shoulder tip pain, as more commonly seen in females with pelvic pathologies. Point-of-care ultrasound may add diagnostic value with the detection of a haemoperitoneum in this context.

Idiopathic Spontaneous Intraperitoneal Hemorrhage Due to Vascular Malformations in the Muscularis of the Stomach: A Case Report

Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a phenomenon caused by spontaneous rupture of intra-abdominal visceral vessels, and vascular malformations (VMs) leading to ISIH are rare in previously reported cases. VMs of the gastric wall, which are commonly located in the mucosa and submucosa, mostly lead to upper gastrointestinal bleeding rather than intraperitoneal hemorrhage. To our knowledge, this is the first report of ISIH caused by VMs in gastric muscularis. In the current case, a 22-year-old male patient presented with sudden abdominal pain for 4 h, accompanied by tachycardia and hypotension. CT revealed a hematoma in the omental bursa and fluids in abdominopelvic cavities. Then intraperitoneal hemorrhage was confirmed after abdominal paracentesis. Furthermore, ultrasonic gastroscopy indicated that vascular malformation in the muscularis of the stomach probably led to intraperitoneal hemorrhage. The patient recovered after conservative treatment based on fluid resuscitation and remained stable for 12 months of follow-up. This case suggests that VMs located in the gastrointestinal tract may lead to ISIH and ultrasonic gastroscopy is helpful in the diagnosis of VMs in the gastrointestinal tract.