An intra-abdominal hemorrhage of non-traumatic origin, though rare, is a critical medical emergency. It can result from various causes, including visceral, gynecological, vascular issues, or coagulopathy. When worsened by anticoagulants, it can rapidly escalate into a life-threatening situation. Immediate intervention is essential, often requiring surgical exploration or endovascular embolization to prevent severe complications or death.
A 36-year-old woman with rheumatic heart disease, hypothyroidism, and a recent mitral valve replacement and tricuspid valve repair presented in shock, with 3 months of amenorrhea and symptoms of acute hemoperitoneum. Abdominal CT Aortography revealed a 12.5 x 9.5 x 9.2 cm intraperitoneal hematoma (550 cc), with active bleeding likely originating from a minor branch of the left uterine artery. The patient was on anticoagulants at the time. This case highlights a rare cause of spontaneous hemoperitoneum, where timely endovascular embolization led to a favorable clinical outcome.