Abstract / Summary
Spontaneous intra-abdominal hemorrhage is a life-threatening emergency with high mortality, often linked to vascular pathologies or visceral organ rupture. This case report details a rare instance of recurrent hemorrhage and reviews etiological insights. A 72-year-old hypertensive Han Chinese woman of yellow race from China presented with syncope and abdominal pain. Initial assessment revealed hypotension (89/63 mmHg), anemia (Hb 103 g/L), and lactic acidosis (9.46 mmol/L). Abdominal CT demonstrated significant hemoperitoneum. Angiography confirmed bleeding from gastroduodenal artery pseudoaneurysms; coil embolization was performed successfully. On postoperative day 2, massive hematemesis recurred. Repeat angiography revealed extravasation from the right gastroomental artery. Secondary embolization (coils + cyanoacrylate glue) achieved hemostasis. The patient stabilized and was discharged after 22 days. This represents the first documented case of right gastroomental artery hemorrhage following gastroduodenal pseudoaneurysm embolization, potentially associated with retrograde flow. Literature review highlights vascular anomalies (60–70%), tumor rupture (20–30%), and idiopathic causes (5–10%) as primary spontaneous intra-abdominal hemorrhage etiologies. The absence of formal guidelines for non-traumatic hemorrhage underscores the need for standardized protocols. Early CTA and multidisciplinary management are critical for survival.