Dangerous Gastric Artery Rupture after Bench Pressing: What did I do Wrong?

Medical Q&A [Moderated]
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How did my short gastric artery rupture after moderate bench pressing? 28 yo lifter, under warfarin, almost bled out

Hi guys! I’m a 28 year old, generally athletic and healthy, on BBM and lifting programs for years. I have antiphospholipid syndrome (so I live on anti coagulation - warfarin, target INR 2.5-3).

I warmed up paused bench with 80 kg, with my SBD belt perhaps a bit higher/tighter than usual. Normal brace + valsalva, set felt fine, racked, stood up (maybe too quickly) off the bench , and: stabbing pain under left lower ribs , worsening with deep breathing. I was sure it’s a pulled intercostal and went home. I barely slept — breathing was miserable. The next morning, I saw the doctor who thought it was just a strained muscle.

27 hours post workout I’m ghost white, belly is badly swollen, and had fainted. Went to the ER: hemoglobin 9.7 → CT → “massive fresh hemoperitoneum” ( = abdominal bleeding) and rushed to the trauma center. Emergency exploratory laparotomy (belly surgery) finds a ruptured short gastric artery and over two litres (!) of blood sloshing around. They ligated the branch, and gave me two blood transfusions. Discharged after 2 weeks on strict orders: no lifting, no physical activity for at least three months. But hey, I got my life back and I am thankful for that :blush:

Now wondering: WHAT THE HELL HAPPENED?!

Important stats:

  • INR on admission: 3.6 later rising to 4.3.
  • Only ~14 cases of short gastric rupture in PubMed – all after savage vomiting/gaging , none reported after lifting.
  • I’m naturally thin and have a narrow waist (76cm).

Questions for the BBM / MD brains here:

  1. Do you think this was random bad luck (amplified by supratherapeutic anti coagulation), or can tight belt + Valsalva/ fast stand up physically tear a gastric branch/other artery?
  2. Any mechanism by which big intra abdominal pressure/ valsalva could predispose to such a rupture?
  3. Real world recurrence risk? Assuming the vessel is now ligated and INR back in range, can I return to heavy benching? Any modifications (belt lower/looser, avoid huge Valsalva, etc.)?

I’m obviously following up with the docs, but would love experiential insight from community and the BBM docs.

Thanks in advance! :heart: Be healthy!

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Wow, what an incredible story. Very happy to hear you’re okay. Hope you’re healing up alright.

If forced to speculate, this seems mostly like bad luck that was complicated by a tendency to bleed (from anticoagulants).

Mechanistically, we could hem and haw about the forces imposed upon the vasculature from the belt, the bar being paused, and posture. However, this sort of thing happens so rarely, I’m not sure it matters. I do not think the Valsalva is contributory.

I can’t speak to the risk of recurrence or future management, as I’d want to know more about you, the case, and have further follow up. That’s likely best suited for a consult.

If it were me, I would have a hard time avoiding the bench press for very long (once cleared for return to exercise), and I don’t think we can really avoid the Valsalva either. I’m +/- on the belt during the bench press, as I think its best use case is for powerlifters DURING MEETS to reduce fatigue in the lower back. I bench with mine in training during meet prep, otherwise don’t really use it for BP. That said, I can’t say whether or not that would make a big difference either.

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Thank you Jordan!
Yea, I had some hell of a luck.
I am mainly wondering what part of the bench press triggered that. Or is it the fact I’m anticoagulated caused that…
I will deff be contacting you guys after I’m cleared for weights again.

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