Spontaneous Intraperitoneal Hemorrhage (SIPH) : a new Differential Diagnosis for Complications Due to Protracted Vomiting
Stawiarski, K.; Costantino, A.; Gourineni, V.C.; Andres, P.
Connecticut Medicine 80(8): 471-473
2016
ISSN/ISBN: 0010-6178 PMID: 29782782 Document Number: 690047
Spontaneous intraperitoneal hemorrhage (SIPH), or abdominal apoplexy, is a rare complication of protracted vomiting. Although usually seen later in life, increased alcohol consumption may be contributory to the accelerated incidence of SIPH among younger populations. We describe a 22-year-old male who presented with abdominal pain after prolonged retching in the setting of binge drinking. A CT scan identified a highly attenuated intraperitoneal collection measuring 7.6 cm x 11.6 cm x 15.9 cm adjacent to the stomach. Due to hemodynamic instability, exploratory laparotomy was emergently performed and 1600 mL of blood was evacuated. A diagnosis of SIPH was made with bleeding visualized from a short gastric artery. Ultimately, vessel ligation failed to achieve hemostasis at the splenic hilum and a splenectomy was required. Given that a delay in identification may prove fatal, this case highlights the importance of recognizing SIPH as a differential diagnosis for unexplained abdominal pain and shock after persistent vomiting.