Abstract
Spontaneous rupture of a short gastric artery with resultant hemoperitoneum is an exceptionally rare clinical entity that carries a significant risk of impending hemorrhagic shock. This report presents a 23-year-old male who developed acute left upper quadrant pain following forceful vomiting. Initial management was challenged by a concerning decline in hemoglobin. Computed tomography (CT) revealed active extravasation from a splenic artery branch, initially mimicking a ruptured splenic artery aneurysm. However, subsequent urgent angiography failed to identify the active bleeding site, presenting a critical clinical dilemma: to operate or to observe. Given the patient’s relatively stable hemodynamics, rigorous intensive observation and serial monitoring were elected over prophylactic exploratory laparotomy. A follow-up CT scan three days after angiography confirmed the absence of contrast extravasation. This case highlights the diagnostic challenge of abdominal apoplexy and underscores the crucial role of critical decision-making and intensive clinical observation in safely managing hemodynamically stable patients with negative angiography.
Yook Kim, Younghoon Sul
