Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of abdominal apoplexy, arousing clinic doctors’ attention to this disease. Methods Two hundred and thirty-two domestic cases with abdominal apoplexy were analyzed retrospectively and related literatures in and abroad were reviewed. Results Abdominal apoplexy occured mainly patients aged 45 to 70 years in China and 50 to 59 years abroad. It was more common in women than in men, and male to female ratio was 1 to 1.4 in China and 1 to 2.5 abroad. There were various etiological factors to this disease. It was usually abrupt, with complicated clinical manifestation. The main symptoms were abdominal pain and hemorrhagic shock with nauseat, vomiting and diarrhea. Preoperative diagnosis rate of abdominal apoplexy was very low, literatures showed only 1.7% in China and 2.3% abroad. There was no particular evaluation approach. Abdominal cavity puncture, combined with CT, ultrasound, MRI and selective abdominal angiography helped to raise diagnosis rate. Overall postoperative mortality was 7.3%. In 7.8% cases, no bleeding site could be found during laparotomy, and the mortality rate was 41.2%. Conclusion Abdominal apoplexy is rarely seen in clinic with low preoperative diagnosis rate and poor prognosis. The first choice management is exploratory laparotomy, and the key is to ligate ruptured vessels.