Short gastric artery apoplexy after gagging

Abdominal apoplexy, the spontaneous hemorrhage into the peritoneal cavity, is usually caused by a rupture of visceral vessels such as short gastric arteries. Several factors such as pregnancy, hypertension and atherosclerosis have been described in association with abdominal apoplexy. Blunt trauma, inflammatory conditions, aneurysm rupture and rarely vomiting are some predisposing conditions. We report a very unusual case of a patient who had a spontaneous short gastric artery acute hemoperitoneum caused by forceful gagging during teeth brushing. The patient was treated with blood transfusion, fluids resuscitation, laparotomy, and suture ligation of the bleeder vessel. We also review the medical literature of abdominal apoplexy, a rare etiology of acute abdomen that should be recognized early in the Emergency Department.