Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), is a rare but often fatal condition resulting from a variety of disease processes affecting abdominal vasculature. A 30-year-old woman presented with acute abdominal pain and breathlessness and was in class II hypovolemic shock. She had a history of multiple episodes of retching with non-bilious vomiting prior to that. Computed tomography (CT) reported a non-rotation of the gut, gross intraperitoneal free fluid with debris, and possible perforated appendicitis. Laparoscopy revealed a gross hemoperitoneum of 2.5 L, with bowel findings consistent with non-rotation of the gut, but technical difficulty in identifying the source of bleeding led to conversion to laparotomy. A ruptured short gastric artery was ascertained to be the source of bleeding and was successfully ligated. A retrospective review of the preoperative CT showed intraperitoneal free fluid with Hounsfield unit measurements of 48 and 52, suggestive of acute hemoperitoneum. ISIH is often a delayed diagnosis or missed diagnosis due to its low incidence. The presence of vomiting and abdominal pain with hypovolemic shock, especially in a young individual, should raise the suspicion of ISIH, which can be confirmed via early CT imaging to facilitate achieving hemostasis during surgery.

Endometriosis involving the bowel is a form of deep infiltrating endometriosis (DIE). The endometriotic lesions can infiltrate the bowel layers mimicking a malignancy. The majority of bowel involvement happens in the colon and rectum. We report our experience in surgically managing rectal endometriosis in two patients, one via a conservative approach and the other with a more radical approach and their associated short-term and long-term outcomes are observed. In principle, surgery remains the mainstay of treatment in managing rectal DIE with adjuvant hormonal therapy. The selection of surgical approach should be based on disease factors such as the size of the lesions and extent of the disease, patient factors including fitness for surgery and expectations as well as logistics and resource limitations.

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the alimentary canal and are postulated to have originated from the interstitial cells of Cajal. We present three patients with an age range from 43 to 63 years old diagnosed with GIST of the gastroesophageal junction (GEJ). All patients were noted to have submucosal lesions through gastroscopy, in which the largest was 5 cm × 7 cm in size. All of them underwent emergent surgery due to various reasons, and the Merendino procedure was performed as the surgery of choice. All of them recovered well and were discharged on days 10–12. The histopathological examination demonstrated a GIST. Merendino procedure can improve patients' digestive functions and nutritional status, leading to a better quality of life after surgery with a reduction in postoperative complications. This case series demonstrated proximal gastrectomy with Merendino procedure reconstruction as a safe, efficient, and feasible approach in treating gastric GISTs at the GEJ.