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PubMed2000

Hemopneumothorax and hemoperitoneum in a case with large cell carcinoma of the lung.

Hemopneumothorax and hemoperitoneum coincide rarely in nontraumatic cases. Here, a 70-year-old male presented a left axillary lymph node and was diagnosed as having metastatic squamous cell carcinoma. Under the same diagnosis, another lesion developed in the right femur and was resected. One year later, computed tomography detected another tumor in the left adrenal gland. Shortly afterwards, left pneumothorax developed and a chest operation revealed hemopneumothorax due to a ruptured cavitary form of large cell carcinoma. The serum showed a human chorionic gonadotropin-beta level of 1,100 ng/ml. At three-months later, he died of hemoperitoneum. The autopsy demonstrated hepatic metastases and a ruptured adrenal metastasis; microscopy showed marked trophoblastic and squamous cell changes in these organs. This patient was unique in that the rupture of the pulmonary and the adrenal lesions caused clinical manifestation.

Aged↗
PubMed2000

Hemoperitoneum and disseminated intravascular coagulation in two neonates with congenital bilateral neuroblastoma.

We report two neonates with anemia, hemoperitoneum, and bilateral palpable abdominal masses. Both developed bleeding: a hemoperitoneum in one and visceral hemorrhages secondary to disseminated intravascular coagulation in the other. Each child was thought to have an unusual complication of adrenal hemorrhage, as the masses were of mixed echogenicity. However, histological evaluation revealed neuroblastoma. These cases point out the diagnostic dilemma of a mixed echogenicity suprarenal mass in the neonatal period and emphasize that local and disseminated bleeding can occur as a major manifestation of neuroblastoma.

Adrenal Gland Neoplasms↗
PubMed2005

A new method to approach exact hemoperitoneum volume in a splenic trauma model using ultrasonography.

In the trauma setting, the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) accurately detects hemoperitoneum. Currently, only an approximate evaluation of the volume of free intraperitoneal fluid (FIPF) can be done by imaging modalities such as ultrasound (US). The aim of this study was to correlate the thickness of FIPF measured by US in different sites of the peritoneal cavity with the total volume of an experimental post-traumatic hemoperitoneum. An intra-abdominal collection with ongoing bleeding was simulated in eight cadavers with no previous abdominal surgery. Between 200 and 2000 ml of saline solution was instilled into the left hypochondrium of eight non-embalmed cadavers. During the instillation, FIPF thickness was measured every 200 ml by US in six different declivous sites of the peritoneal cavity. The volume of FIPF instilled could be mathematically correlated with fluid thickness in all the sites through the linear equation Y=aX+b, where Y is the volume of FIPF in milliliters, a is 33 (variability coefficient), X is the FIPF thickness in millimeters and b is 470 ml (minimum volume detectable by US). The best correlation between thickness and volume was obtained in the hepatorenal pouch (Morrison pouch). Evaluation of the impact of intraperitoneal hemorrhage on the hemodynamic state of spleen trauma patients is of paramount importance for the surgeon, who has to decide whether to perform a laparotomy for hemostasis or not, specially when intra- and extra-abdominal injuries conjointly exist. After clinical validation, this new method to calculate the exact volume of FIPF could be used in current clinical practice of abdominal trauma to assist in the decision-making regarding non-operative treatment of spleen trauma.

Aged↗
PubMed2001

Acute hemoperitoneum caused by rupture of omentum adhesions after running.

The case of a 37-year-old man in whom a massive hemoperitoneum developed a few hours after running is described. The patient disclaimed any trauma and clearly noted that symptoms appeared after running. Findings at laparoscopy showed that the bleeding was caused by the rupture of adhesions between the omentum and left inguinal abdominal wall. These adhesions, which had resulted from a previous laparoscopic transperitoneal bilateral inguinal hernia cure, were resected. Recovery was simple and follow-up assessment was uneventful. Hemoperitoneum secondary to the rupture of intraperitoneal adhesions is very rare in the absence of precipitating trauma. However, the trauma can be trivial. Rupture of intra-abdominal adhesions has been described after sexual intercourse or mobilization of the patient under general anesthesia. Disruption of adhesions by insufflation or mobilization of organs under laparoscopy also is reported. The transperitoneal approach to laparoscopic treatment of inguinal hernia can be responsible for late intestinal obstruction caused by intra-abdominal adhesions, but late hemorrhagic complication has not yet been reported.

Acute Disease↗
PubMed2000

Hemoperitoneum secondary to exophytic leiomyoma: report of a case.

We report herein the case of a 63-year-old male with hemoperitoneum secondary to exogastric leiomyoma. The patient had been receiving anticoagulation therapy for a cerebral embolism and complained of sudden, severe abdominal pain. A sonogram and computed tomography scan showed an exogastric mass and massive ascites. A peritoneal puncture proved the presence of an intraperitoneal hemorrhage. An emergency laparotomy revealed a pedunculated bleeding tumor, thus confirming the preoperative diagnosis of a ruptured exogastric tumor. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma. Other authors have reported hemoperitoneum secondary to gastric myogenic tumors, but no cases of leiomyomas could be found in the literature.

Biopsy, Needle↗
PubMed2006

Massive hemoperitoneum due to ruptured inferior phrenic artery pseudoaneurysm after blunt trauma.

There had been no previous reports of ruptured pseudoaneurysm of inferior phrenic artery shortly after blunt abdominal trauma. Traumatic arterial pseudoaneurysms are either iatrogenic or the result of penetrating injuries and one of the sequelae of trauma. Post-traumatic pseudoaneurysm develops at varying time intervals after the initial insult. To our knowledge, this is the first report of massive hemoperitoneum caused by ruptured inferior phrenic artery pseudoaneurysm after blunt trauma. Pseudoaneurysm of inferior phrenic artery in patient with diaphragm injury is potentially a life-threatening condition and requires urgent management. Diagnosis of ruptured inferior phrenic artery pseudoaneurysm is based on clinical assessment combined with radiological investigations. We report a case of ruptured left inferior phrenic artery pseudoaneurysm as one aspect of massive hemoperitoneum caused by blunt abdominal trauma.

Accidents, Traffic↗
PubMed1983

Autotransfusion in gynecologic hemoperitoneum.

The loss of blood associated with acute hemoperitoneum accounts for a significant portion of the mortality in gynecologic practice. This report proposes the salvage of intraperitoneal blood for autotransfusion by a device developed for use in open heart operations. Two cases are presented which exemplify the indications for and limitations of autologous transfusion from hemoperitoneum.

Adult↗
PubMed1990

Hemoperitoneum as a result of coital injury without associated vaginal injury.

Hemoperitoneum as a result of coital injury without associated vaginal injury is an extremely rare entity, and evidence by only five cases that have been reported in the medical literature to date. We report five additional cases encountered in two medical centers. Two of these were ruptured corpus luteum cysts, one was a laceration of the round ligament, another was a laceration of an ovary, and the fifth was rupture of a serous cystadenoma. This diagnosis should be considered in patients with hemoperitoneum after coitus.

Adult↗
PubMed1989

Massive hemoperitoneum following rupture of hepatic metastases from unsuspected choriocarcinoma.

Spontaneous massive hemoperitoneum in a reproductive-aged woman is usually associated with ectopic pregnancy. An unusual cause of intraperitoneal hemorrhage is presented: spontaneous rupture of hepatic metastases from unsuspected choriocarcinoma in a 29-year-old woman 4 weeks postpartum. Although choriocarcinoma is known to have the potential for subsequent hemorrhage of secondary sites, massive hemoperitoneum due to rupture of hepatic metastases is rare. In this case report, the presentation, prognosis groups, and treatment modalities are presented.

Adult↗
PubMed2002

Massive and acute hemoperitoneum due to rupture of the uterine artery by erosion from an endometriotic lesion.

OBJECTIVE: To report a case of acute hemoperitoneum due to erosion of the uterine artery by an endometriotic lesion of the left ovary. DESIGN: Case report and review of literature. SETTING: University medical center. PATIENT(S): A 39-year-old nulliparous woman with stage 3 endometriosis. INTERVENTION(S): Operative laparoscopy followed by laparotomy, oophorectomy, and ligation of the bleeding uterine artery. RESULT(S): Patient is fully recovered and is attempting to conceive. CONCLUSION(S): An endometriotic lesion eroded the wall of the uterine artery, causing massive, acute hemoperitoneum. Such an event may be overlooked during laparotomy and attributed to the trauma of surgery.

Adult↗
PubMed2000

A practical approach to hemoperitoneum in the dog and cat.

Hemoperitoneum can occur in animals of any age and can result from many different disease processes. Neoplastic and traumatic conditions are the most common causes. Many of these patients present with hemodynamic instability but stabilize with rational intravenous fluid therapy and abdominal counterpressure. Surgical exploration of the abdomen is indicated in many situations. Surgical therapy is aimed at resection or control of the bleeding focus, removal of any devitalized tissue, and biopsy of additional sites of suspicion. Optimal treatment for all patients with hemoperitoneum frequently requires advanced critical care, anesthesia, and surgical techniques. Finally, the treatment outcome is variable and dependent on the underlying cause and its severity.

Animals↗
PubMed2006

Spontaneous rupture of a large exogastric hemangioma complicated by hemoperitoneum and sepsis.

Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangioma of the stomach presenting with spontaneous rupture and sepsis is rare. We report a 22-year-old male who presented at the emergency room with sudden-onset epigastric pain, intractable nausea, and vomiting. Fever, tachycardia, leukocytosis and peritonitis were found on examination after admission. Computed tomography revealed a single, well-defined homogeneous lesion measuring approximately 6 x 8 x 9 cm in size over the left upper abdomen and hemoperitoneum. Laparotomy was performed because of intra-abdominal hemorrhage, peritonitis, and fever. During the operation, a dark red tumor was found on the greater curvature side of the stomach, accompanied by bleeding and hemoperitoneum. The tumor was removed and a wedge resection of the stomach and partial omentectomy were performed. Histopathologic examination of the excised tumor revealed mixed cavernous-capillary hemangioma with central necrosis. The postoperative course was uncomplicated. The pathogenesis of spontaneous rupture and sepsis in this case may have resulted from pedicle torsion accompanied by ischemia, central necrosis, rupture of hemangioma and subsequent peritonitis and sepsis.

Adult↗
PubMed2000

[Neonatal hemoperitoneum].

PATIENTS AND RESULTS: A series of four cases observed in the department of pediatric surgery in Monastir between 1990 and 1998 are reported. The diagnosis was made in the two first days of life. The clinical features associated paleness, shock and abdominal distension. Ultrasonography revealed that the hemoperitoneum was associated with liver hematoma in three cases and with retroperitoneal hematoma in two cases. Three infants required emergency hemostatic laparotomy. The fourth was stabilized by initial resuscitation. One infant died at the age of six months following subarachnoid hemorrhage and subdural hematoma. No complication occurred in the three remaining patients. CONCLUSION: The pathogeny, clinical features and treatment of the hemoperitoneum in the newborn are discussed. The authors stress preventive measures, the only way to decrease the incidence of this neonatal complaint.

Hematoma↗
PubMed2000

Laparoscopic surgery with intraoperative autologous blood transfusion in patients with heavy hemoperitoneum due to ectopic pregnancy.

Patients with ectopic pregnancy complicated by heavy hemoperitoneum generally undergo immediate laparotomy, and homologous blood transfusion is sometimes started before the operation. Two women underwent laparoscopic surgery for heavy hemoperitoneum (2600 and 1900 ml) due to ectopic pregnancy. The aspirated blood was reinfused during operation through a leukocyte-reduction filter after lavage with an autologous blood-salvage transfusion apparatus.

Adult↗
PubMed2002

[Hemoperitoneum secondary to the rupture of superficial veins of a uterine leiomyoma].

The most frequent cause of gynaecological hemoperitoneum is ruptured ectopic pregnancy. An uncommon cause of hemoperitoneum is rupture of uterine leiomyoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to ruptured uterine leiomyoma vessels. The patient was treated with myomectomy and the postoperative course was uneventful. These case suggest that massive intra peritoneal hemorrhage associated with uterine leiomyoma should be considered in women with hypovolemic shock and pelvic mass.

Adult↗
PubMed2006

[Spontaneous hemoperitoneum: diagnosis, prognosis and possible therapeutics].

We report the case of a 58-year-old diabetic man admitted to the hospital in a comatose state due to medicamentous hypoglycemia in a context of hypovolemic acute renal failure. Hypovolemia was due to hemoperitoneum in a alcoholic patient with cirrhotic hepatic failure. CT-scan and arterial angiographies revealed a voluminous isolated hepatic mass with active bleeding suggesting the diagnosis of spontaneous bleeding from a hepatocellular carcinoma. The hemorrhage resolved after selective arterial embolization, but the patient died two weeks later from an infectious cause. The differential diagnosis of a spontaneous hemoperitoneum and possibilities of treatment in the case of ruptured hepatocellular carcinoma are discussed.

Carcinoma, Hepatocellular↗
PubMed2001

Rupture of liver cell adenoma with fatal massive hemoperitoneum resulting from minor road accident.

Blunt abdominal trauma can cause rapid death resulting from serious injuries of internal organs. The liver is commonly involved and may show tearing, usually in its upper surface, resulting in hemoperitoneum eventually leading to death. Minor trauma implies serious liver damage only when previous pathologic changes causing enlargement of the organ are present. The case of a 25-year-old woman who died as a consequence of a minor road accident is reported. At autopsy, the body showed no external injuries, the only relevant finding being a massive hemoperitoneum from the rupture of an unusually large liver cell adenoma. Liver cell adenomas carry a serious risk of spontaneous rupture, which may result in the death of the patient. The occurrence of the rupture after a minor blunt abdominal trauma is highly unusual.

Accidents, Traffic↗