Cocaine use is now relatively common in the occidental societies and is responsible for a long list of medical complications involving almost every organ system in the body. The digestive complications are less known. We report a case of a young man who presented to the emergency department with violent abdominal pain and several episodes of vomiting after using intranasal cocaine. The abdominal pain was caused by a massive haemoperitoneum with no evidence of any underlying pathology. This case shows that we have to consider the possibility of a lethal abdominal haemorrhage in the differential diagnosis of acute abdominal pain in cocaine abusers.