Introduction: Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare and often life-threatening condition. It is described as intra peritoneal hemorrhage secondary to the tear of an intra-abdominal visceral blood vessel, in the absence of underlying pathology or trauma, the cause of which cannot be easily identified. Presentation of case: Herem we describe a rare case of a 32-year-old man who presented with a day history of diffuse abdominal pain, nausea, vomiting, and loss of appetite. He had no previous history of bleeding diathesis or history of trauma. His past medical history was unremarkable. Discussion: Abdominal ultrasonography was immediately performed which only indicates intraperitoneal fluid collection. The hemoperitoneum was confirmed by ultrasound-guided puncture. The patient was hemodynamically unstable after resuscitation therefore he was immediately transferred to the operating room for exploration after adequate preparation. Exploratory laparotomy was done and around 2 L of free blood with few clots were evacuated. A thorough and systematic exploration of the abdomen including the spleen, liver, bowel, kidneys, and mesentery revealed no source of bleeding or pathology. The postoperative course was unremarkable. The patient was discharged after 7 days of hospital stay with a stable condition. Conclusion: In a patient presented with acute abdomen with hemodynamic instability treating physician should consider ISIH as differential diagnosis.
Kemal et al. (Wed,) studied this question.