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PubMed1985

Hemoperitoneum from ruptured omental varices.

We report a patient with hemoperitoneum from rupture of intraperitoneal varices. Hemoperitoneum is rare. Nevertheless, it should be easily recognized in a patient with abdominal pain and distension, a falling hematocrit in the absence of external blood loss, and gross blood in the abdominal fluid. The syndrome is another justification for early paracentesis in patients with abdominal fluid. Mortality remains high despite surgical correction of the bleeding and reflects the severity of the underlying liver disorder.

Aged↗
PubMed1986

Lactic acidosis associated with cirrhosis, hepatoma, hemoperitoneum, and hyperphosphatemia.

A patient with cirrhosis developed hemoperitoneum, lactic acidosis, and hyperphosphatemia in the absence of shock. At post-mortem examination occult multicentric hepatocellular carcinoma eroding the liver capsule was present. The case emphasizes the central role of the liver in lactic acidosis, indicates that hemoperitoneum may precipitate this complication, and documents the association of lactic acidosis and hyperphosphatemia.

Acidosis↗
PubMed1975

Thoracic aortic clamping for prophylaxis against sudden cardiac arrest during laparotomy for acute massive hemoperitoneum.

Experimental studies in dogs were performed to develop a model simulating clinical patients with penetrating wounds of the major abdominal vessels who develop sudden cardiac arrest following laparotomy and decompression of an acute massive hemoperitoneum. Hypovolemic dogs with a saline-distended tense abdomen and major arterial bleeding after laparotomy develop a sudden deterioration of cardiac function despite raped blood infusion, thus simulating the clinical problem. However, thoracic aortic occlusion before laparotomy and until control of distal arterial bleeding prevented such a cardiovascular collapse. Increased intra-abdominal pressure it itself was determental to cardiovascular function; its sudden release by laparotomy was associated with an improvement in cardiovascular function. An approach of thoracic aortic control before laparotomy is recommended in patients with acute massive hemoperitoneum who remain hypotensive before laparotomy.

Abdominal Injuries↗
PubMed1983

Hemoperitoneum studied by computed tomography.

Three hundred patients who had sustained blunt abdominal injury were evaluated with computed tomography (CT). The images showed areas of hemorrhage by varying attenuation coefficients (average, 45 Hounsfield units; exceeding 30 Hounsfield units in all cases except in those patients with bleeding more than 48 hours old). Small hematomas tended to accumulate near the site of origin while free intraperitoneal bleeding most frequently accumulated in the Morison pouch, paracolic gutters, and pelvis. CT estimates of the extent of hemoperitoneum (small, moderate, or large) correlated well with clinical assessments and surgical findings. Only one false-negative and two false-positive CT interpretations occurred, and each was potentially avoidable in retrospect. CT is sensitive and specific for the diagnosis of hemoperitoneum and can estimate the extent and probable source of bleeding. This information may obviate the need for a peritoneal lavage and laparotomy in many instances.

Abdominal Injuries↗
PubMed1988

Hemoperitoneum after spontaneous rupture of liver tumor: results of surgical treatment.

Five cases of massive hemoperitoneum caused by spontaneous rupture of liver tumors, collected during a 27-year period, are reported. Four patients had a primary liver malignancy and one patient a liver cyst with hemangioma. Initial symptoms were obscure and hemoperitoneum was suspected pre-operatively in only one patient. At operation, a mean of 3100 ml of blood was found in the abdomen. Hemostatis was achieved by liver resection in four patients and by suture ligation in one. Two patients died during or shortly after operation. The three patients surviving the operation had primary liver cancer and lived for 6 months to 6.5 years. It is concluded that liver resection, whenever possible, is the treatment of choice and that pre-operative delay and mortality may be diminished by increased awareness of this condition.

Aged↗
PubMed2001

Abdominal pain and hemoperitoneum: sole presenting symptoms for "leaking AAA" after endovascular repair.

PURPOSE: To describe an unusual presentation of impending aortic endograft rupture and successful endovascular rescue. CASE REPORT: A 77-year-old man with an enlarging aortic aneurysm was treated with a Talent bifurcated endoprosthesis; a moderate endoleak that appeared to be related to either proximal or distal fixation sites was noted in the body of the aneurysm. The patient was observed for 1 month, and repeat imaging demonstrated persistent endoleak without major increase in the aneurysm diameter. Another examination was scheduled for 3 months hence, but, 2 months later, the patient presented with abdominal pain and a hemoperitoneum. A proximal extension cuff resolved the leak and led to resolution of the hemoperitoneum. CONCLUSIONS: A leaking aneurysm can be repaired using endovascular techniques in patients with an existing endograft. The need for frequent imaging surveillance of patients with endoleak is underscored.

Abdominal Pain↗
PubMed2005

Hemoperitoneum secondary to spontaneous rupture of hepatic metastasis from lung cancer.

We describe a rare case of hemoperitoneum secondary to spontaneous rupture of hepatic metastasis from lung cancer. A 72-year-old man with non-small cell lung cancer was admitted to our hospital with sudden onset of right upper abdominal pain and hypovolemic shock. Laboratory tests showed severe anemia. Abdominal contrast-enhanced computed tomography revealed massive ascites and multiple liver metastases. Rupture of a metastatic liver tumor was suspected. Only palliative therapy was performed. The patient's general condition gradually worsened, and he died 2 months after admission. Autopsy examination revealed hemoperitoneum due to a ruptured metastatic liver tumor originating from pulmonary squamous cell carcinoma.

Aged↗
PubMed2003

A spontaneously ruptured gastric stromal tumor with cystic degeneration presenting as hemoperitoneum: a case report.

We report a case of a 38-yr-old man with a spontaneously ruptured gastric stromal tumor presenting as hemoperitoneum in outpatient clinic. He visited our hospital with generalized abdominal pain after abdominal CT scan for the evaluation of the asymptomatic palpable abdominal mass. Repeated abdominal CT scan showed a size decrement of cystic mass compared with the previous abdominal CT scan, and newly developed fluid collection in the left paracolic gutter. An emergency laparotomy revealed a ruptured gastric stromal tumor with bloody fluid in the peritoneal cavity. Immunohistochemical examination revealed positive reactivity to C-kit protein and CD34. The patient presented with hemoperitoneum due to spontaneous rupture of the tumor, which is an extremely rare complication.

Adult↗
PubMedDate not supplied

Traumatic hemoperitoneum in 28 cases: a retrospective review.

This study was conducted to evaluate and describe presenting clinical signs, course, management, and outcome of small animal patients that suffered severe traumatic hemoperitoneum. The medical records of 28 blunt trauma patients diagnosed as having hemoperitoneum and requiring the transfusion of blood products for stabilization were analyzed. The survival rate was 16/28 (57%). Six patients died from natural causes, and six patients were euthanized. Euthanized patients were not considered for the analysis of outcome. The survival rates for six animals that had surgical intervention and 16 animals that were treated medically were 67% and 75%, respectively. Statistically, larger animals had a better prognosis (p less than 0.05, unpaired t-test) for survival. Presenting clinical signs, packed cell volume (PCV), peripheral pulse rate, effusion PCV, site of intra-abdominal hemorrhage, and age were not found to correlate statistically with survival nor with the decision to perform an abdominal exploratory.

Animals↗
PubMed2000

Gastric intramural hematoma and hemoperitoneum in a captive northern fur seal.

A 16-yr-old adult male northern fur seal (Callorhinus ursinus) was found dead in its outdoor pool in November 1995. The animal was maintained at Mystic Aquarium (Mystic, Connecticut, USA) from March 1980 to November 1995. Gross necropsy findings included hemoperitoneum and locally extensive gastric intramural hemorrhage that involved the posterior fundic, antral, and pyloric regions and extended into the duodenum. The gastric mural thickening grossly resembled hemangioma, and the gastric serosa was ruptured at the site of maximal mural expansion. In histologic sections of the stomach, a cribiform network of fibrin, which encompassed numerous variably-sized aggregates of closely packed erythrocytes, markedly expanded the submucosa. No vascular endothelium was identified in serial histologic sections of the expanded gastric submucosa stained with hematoxylin and eosin or immunohistochemically with antibodies to vimentin and Factor VIII-related antigen, establishing an absence of hemangioma. Carstairs' and Weigert's histochemical stains confirmed that the framework expanding the submucosa was fibrin. Although the appearance of the gastric wall resembled hemangioma, a population of neoplastic endothelial cells was not identified within the submucosal expansion of hemorrhage and fibrin, and microscopic evidence was most consistent with the diagnosis of gastric intramural hematoma. This lesion is a rare pathologic event that has not been reported in marine mammals, but one that should be included in diagnostic considerations of hemoperitoneum and gastric mural expansion.

Animals↗
PubMed1999

[Angiodysplasia of the duodenum with arteriovenous shunts, sub-serosal prevalence and interstitial elastosis; peritonitis and rupture of sub-serous dysplasic vessels and hemoperitoneum. Description of a case and review of the literature].

We present a case report of a 74 year old man, affected by angiodysplasia of the duodenum, which developed in peritonitis and hemoperitoneum. After undergoing two surgical interventions, it is 14 days since he died. First of all, the importance of this case is due to the extreme rarity of the angiodysplasia of the duodenum, specially when it becomes worse in peritonitis and hemoperitoneum, this case having been described only one time till now, then the localization mainly sub-serousal and lastly the presence of a component, characterized by an elastotic nature, disposed in islets and interstitial widespread also among the glands, which we have first described in literature.

Aged↗
PubMed2001

Vaginal bleeding from massive hemoperitoneum. A case report.

BACKGROUND: A gynecology service is often asked to consult and evaluate in-house patients with vaginal bleeding. CASE: A 31-year-old, Asian woman with a history of end-stage renal disease and hemodialysis was admitted to the hospital with a falling hematocrit. She subsequently began to have heavy vaginal bleeding. Computed tomography suggested a peritoneal-cervical fistula. Subsequent exploratory laparotomy documented that the bleeding was caused by retrograde flow of a hemoperitoneum. CONCLUSION: This appears to be the first reported case of retrograde flow from a hemoperitoneum causing vaginal bleeding. Although unusual, this case expands the differential diagnosis when evaluating vaginal bleeding.

Adult↗
PubMed2002

[Massive hemoperitoneum from rupture of an intra-peritoneal varix].

Rupture of an intra-abdominal varix in a patient with portal hypertension is a rare but severe cause of massive hemoperitoneum. The authors report the case of a patient with alcoholic cirrhosis that presented to the emergency department with hypovolemic shock. Imaging showed massive hemoperitoneum, severe portal hypertension and suggested the diagnosis of spontaneous rupture of an intra-abdominal varix, confirmed at laparotomy.

Abdomen↗
PubMedDate not supplied

Solid and cystic tumor of the pancreas with massive hemoperitoneum.

A case of a solid cystic tumor (SCT) of the pancreas with massive hemoperitoneum occurring in a 31-year-old woman is reported. She was admitted with abdominal pain and rebound tenderness. Computed tomography (CT) disclosed a large tumor consisting of both solid and cystic components in the body of the pancreas. Within 12 hours after admission, she exhibited exacerbation of pain and hemoperitoneum on CT with deterioration of general condition and anemia. Celiac artery angiography demonstrated the tumor as a hypovascular mass. SCT of the pancreas was suspected, and emergent laparotomy was performed. In the surgical procedure, tumor in the body of the pancreas with rupture was detected. Distal pancreatectomy was performed with removal of the regional lymph nodes. There was no evidence of metastatic disease in the abdomen. The cut surface of the tumor exhibited areas of cystic degeneration containing hemorrhagic friable materials. Microscopically, the tumor cells were mainly cubic or cylindrical peripherally in pseudo-papillary formation. Postoperative recovery was normal and she was discharged on the 15th postoperative day. Three years after operation, she is free of disease without findings of recurrence.

Adult↗
PubMedDate not supplied

[Spontaneous rupture of giant subcapsular hemangioma of the liver with hemoperitoneum and hemorrhagic shock: a case report].

Cavernous hemangioma is the most common benign tumour of the liver and is found quite commonly during abdominal ultrasonography performed for other diseases. It is often asymptomatic and undergoes enlargement in fewer than 10% of cases. Spontaneous rupture of a giant hepatic hemangioma (diameter > 4 cm) with hemoperitoneum occurs very rarely. Only 32 cases have been reported in a recent review of the medical literature, with an operative mortality of more than 35%. We describe a new case of a giant subcapsular hemangioma localised in hepatic segments II and III in an 84-year-old woman, which ruptured spontaneously into the abdominal cavity and presented with hemoperitoneum and hypovolaemic shock. The hemangioma was diagnosed preoperatively by spiral CAT and treated successfully with emergency hepatic bisegmentectomy.

Aged, 80 and over↗
PubMed2005

Fatal hemoperitoneum from traumatic gallbladder avulsion: an autopsy case report.

This report describes a rare autopsy case of death due to gallbladder injury. The victim was a 63-year-old man, with a clinical history of liver cirrhosis and alcohol abuse. The postmortem examination revealed fatal hemoperitoneum from traumatic gallbladder avulsion. Related injuries were observed in the right hypochondriac region. Normal distended gallbladder, liver cirrhosis and alcohol abuse were considered to be the predisposing factors. The gradual development of bleeding from the small vessels of the gallbladder and the liver bed may have caused extensive hemoperitoneum.

Gallbladder↗
PubMedDate not supplied

An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immunoglobulin deficiency.

Wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. It is usually described in adults, being most common in the multiparous women of childbearing age. A case of a 14-year-old girl with a past history of splenomegaly and immunoglobulin A (IgA) deficiency, who presented with a sudden onset of abdominal pain, is presented. Diagnosis of hemoperitoneum secondary to torsion of a wandering spleen was made by computed tomography scan and Doppler ultrasound. Laparoscopy revealed hemoperitoneum owing to a ruptured and infarcted spleen. Laparotomy was undertaken and open splenectomy was successfully performed. The patient was discharged after an uneventful postoperative course that was not punctuated by any major complication. Management of this rare surgical emergency is discussed. Based on the details of this case, the authors hypothesize that IgA deficiency causes splenomegaly, which in turn predisposes to ligamentous laxity and splenic torsion.

Adolescent↗