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Angiomatoid fibrous histiocytoma (AFH) is a rarely seen soft tissue tumor often affects children or young adults. The tumor possesses intermediate behavior and usually arise in superficial soft tissue in trunk and extremities, visceral organs such as the ovary, vulva, brain, and lung. We present a 77-year-old old woman who suffered from a sudden onset of abdominal pain with hypovolemic shock. Vital signs showed tachycardiac hypotension (blood pressure: 80/64 mmHg; heart rate. 106 /minute). On physical examinations, patient presented with pale conjunctiva, diffuse abdominal tenderness and rigidity. Bedside sonography shows ascites with heterogeneous echogenicity and a cystic lesion with 2.88 cm in diameter in left upper quadrant (LUQ) abdominal area. Under the impression of hemoperitoneum caused by a ruptured vascular lesion, computed tomographic angiography (CTA) was performed and revealed one 2.5 cm cystic lesion with extravasation of contrast medium raising concern of ruptured space-occupying lesion with hemoperitoneum. Laparoscopic hemostasis by the general surgeon was performed. After resection the cystic lesion, the patient recovered smoothly and discharged 10 days after surgery. The definite pathologic diagnosis is AFH. This is the first case describing intra-abdominal AFH with acute abdomen and hemorrhagic shock.