PMC9474647_01
(A) Enhanced computed tomography (CT) of the abdomen. Red arrow showed a 10 x 5.2 cm2 high-density shadow in the gastro-pancreatic gap. (B) Gastroscopy showed that the gastric mucosa was smooth and had no ulcer or bleeding spot in the upper digestive tract.
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F1
Abdominal enhanced computed tomography (CT) showed a 10 x 5.2 cm2 hemoperitoneum in the gastro-pancreatic gap in addition to the massive hemoperitoneum around the spleen and in the rectovesical space, which was connected with the hemoperitoneum around the liver through the Winslow foramen (Figure 1A); and the size and density of each solid organ were normal. Gastroscopy showed that the gastric mucosa was smooth, and no ulcer or bleeding spot was observed in the upper digestive tract (Figure 1B).
(A) Enhanced magnetic resonance imaging (MRI) revealed no sign of space-occupying lesion. Red arrow showed a hematoma in the gastro-pancreatic gap. (B) Endoscopic ultrasonography (EUS) illustrated the vascular malformation in the muscularis of the stomach. Blue arrow showed a hypoechoic shadow. Red arrow showed a 1.3-mm diameter blood flow signal was continuous between the muscularis propria and the hypoechoic shadow.
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F2
To clarify the reason for the hemorrhage, enhanced magnetic resonance imaging (MRI) was performed, which revealed a hematoma in the gastro-pancreatic gap, without signs of space-occupying lesion and other indications about the source of bleeding (Figure 2A). In addition, Doppler ultrasonography showed that the blood flow signal was continuous between the muscularis propria and hematoma, which was considered as the vascular malformation in the muscularis of the stomach (Figure 2B).
Timeline from emergency to follow-up.
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F3
The follow-up after 1 year showed that the patient had no signs of recurrence (Figure 3). The timeline from emergency to follow-up is presented in Figure 3.