Spontaneous hemoperitoneum due to rupture of short gastric artery after vomiting.

We report a 25-year-old man who initially presented acute epigastric pain followed by vomiting after the ingestion of alcohol and cocaine. He denied having any significant medical history or having undergone any trauma. On arrival in the emergency room, he had upper abdominal pain but without any peritoneal sign. His biochemical profile showed 14,300 white blood cell and neutrophilia, and the blood hemoglobin level dropped from 11.4 to 7.3 g/L, hypotension and pallor skin. After stabilization of his vital sign in the Intensive Care Unit, he underwent ultrasonography and contrast-enhanced computed tomography (CT) of the abdomen (Fig. 1), which revealed a hematoma in the lesser sac, and massive fluid collection or bloody ascites was also found in subhepatic and Morrison’s spaces. The patient underwent emergency exploratory laparotomy to stop the spontaneous bleeding from a small branch of the short gastric artery, which was ligated without complication, during the operation, 1500mL bloody ascites was noted in the peritoneal space and 500mL blood clot had impacted on the lesser sac. The patient received 4 U of packed red blood cells during the surgery and recovered uneventfully.