Hemoperitoneum (also haemoperitoneum, sometimes also hematoperitoneum) is the presence of
blood in the
peritoneal cavity. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Hemoperitoneum is generally classified as a surgical emergency; in most cases, urgent
laparotomy is needed to identify and control the source of the bleeding. In selected cases, careful observation may be permissible. The abdominal cavity is highly distensible and may easily hold greater than five liters of blood, or more than the entire circulating blood volume for an average-sized individual. Therefore, large-scale or rapid blood loss into the abdomen will reliably induce hemorrhagic shock and, if untreated, may rapidly lead to death.
Causes
Causes of hemoperitoneum include:
* Penetrating trauma
* Blunt trauma, most commonly injuries to solid organs such as the
liver and
spleen.
* Vascular accidents, such as rupture of an
abdominal aortic aneurysm, iliac aneurysm, or splenic aneurysm.
* Bleeding due to a ruptured
ectopic pregnancy
Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...
or
uterine rupture.
* Rupture of corpus luteum in some cases.
* Less commonly, bleeding due to a perforated
gastric ulcer
Peptic ulcer disease (PUD) is a break in the inner lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. An ulcer in the stomach is called a gastric ulcer, while one in the first part of the intestines i ...
.
* Bleeding due to rupture of an intra-abdominal neoplasm, (e.g.,
Hepatoblastoma)
*
Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts o ...
* People on high dose of anticoagulants (blood thinners)
* Perforation of the colon
Diagnosis
Hemoperitoneum can be reliably diagnosed with the following examinations:
*
Focused assessment with sonography for trauma (FAST)
*
Paracentesis or
diagnostic peritoneal lavage
*
Computed tomography
A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
* Diagnostic
laparoscopy or
exploratory laparotomy
Treatment
Initial management consists of immediate blood transfusion if the patient is in hemorrhagic shock. Classically, hemoperitoneum was an indication for emergency surgery to locate the source of bleeding and also to recover spilled blood from the peritoneal cavity and to use it for auto-transfusion if it has not been contaminated by ruptured bowel contents. The method of control depends on the source of blood loss. Vascular bleeding, i.e. from a blood vessel, would be treated by clamping and ligation of the offending vessel, or repair of the vessel in the case of major arteries such as the aorta or mesenteric arteries. Bleeding from the spleen most often requires splenectomy, or removal of the spleen, usually but not always in the form of a total splenectomy. Bleeding from the liver might be controlled by application of hemostatic sponges, thrombin, or more recently, argon beam cauterization.
With modern diagnostic aids such as
computed tomography
A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...
(CT) scans, certain injuries such as low-grade lacerations of the spleen may be diagnosed early and observed, with surgical options deferred unless clinical deterioration obligates them. In rare occasions, rupture of an Abdominal Aortic Aneurysm may be repaired via an
endovascular technique, though this is generally not performed in the setting of acute rupture.
References
External links
{{Bleeding and clotting disorders, us=y
Peritoneum disorders
Medical emergencies