Initial emergency gastroscopy confirmed no active intraluminal bleed. However, large extrinsic compression of the greater curvature was noted during the scope. Patient proceeded to emergency laparotomy, which demonstrated large subserosal hematoma of the gastric body degloving the gastric serosa, resulting in large volume hemoperitoneum. Bleeding was controlled by ligating the short gastric artery and removal of the spleen. 

The exact cause of hemorrhage in this patient is not identified. However, the working diagnosis is of short gastric artery rupture from recent retching and vomiting. Variceal bleeding is considered much less likely in this case given the contrast extravasation in arterial phase. 

There have been several case reports of vomiting being the precursor of short gastric artery rupture ^1,2. It is thought that vomiting causes gastric twisting and pulling on the gastro-splenic ligament that result in short gastric artery rupture ².