[HEMOPERITONEUM IN THE NEWBORN. A CASE OF HEMOPERITONEUM CAUSED BY POSSIBLE RUPTURE OF THE LIVER WITH FAVORABLE EVOLUTION].
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Hemoperitoneum↗
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[Hemoperitoneum in the development of various tumors of the ovaries; report of a case of hemoperitoneum with luteinic cyst of the ovary].
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Abdomen↗
[Autotransfusion in hemoperitoneum. Personal technic: apropos of 7 cases of hemoperitoneum caused by rupture of extrauterine pregnancy].
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Blood Transfusion↗
Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis.
OBJECTIVES: To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Single-center retrospective case review of patients on CAPD over a 10-year period. SETTING: Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. PATIENTS: 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. MAIN OUTCOME MEASURES: Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D4/D0) with standard 2-L 2.5% glucose dialysate were assessed. RESULTS: There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24-76 years) and mean duration of dialysis was 61.6 months (range 2-166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2-12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1-37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes (p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes (p = 0.91) or survival (p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. CONCLUSIONS: Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.
Adult↗
Hemoperitoneum in patients with ascites.
OBJECTIVES: To review existing data on the pathophysiology and clinical presentation of hemoperitoneum in patients with ascites and to familiarize practicing clinicians who take care of such patients with the therapeutic options currently available for management of this complication. METHODS: Relevant English-language articles published between January 1988 and November 1996 were identified through MEDLINE search, using the key words "hemoperitoneum" and "ascites." Articles cited in the bibliographies of these articles were searched manually. Published papers that contained data on hemoperitoneum in general and on hemoperitoneum developing in patients with ascites were reviewed. RESULTS: In patients with ascites, hemoperitoneum can develop spontaneously or can follow abdominal trauma and diagnostic or therapeutic procedures. Spontaneous bleeding into ascites usually develops insidiously and may not cause hemodynamic instability, even in patients with cirrhosis. Massive acute hemoperitoneum from a ruptured intraperitoneal varix is an unusual complication of portal hypertension requiring prompt surgical treatment. Acute hemoperitoneum develops in 5-15% of patients with hepatocellular carcinoma requiring transcatheter arterial embolization. Metastatic liver tumors cause bloody ascites infrequently; however, this is a common complication of ovarian carcinoma. CONCLUSIONS: Hemoperitoneum is a severe complication in patients with ascites. When it develops spontaneously, it is usually related to the same disease process that caused the formation of ascites. Massive bloody ascites develops acutely after the rupture of intra-abdominal varices or hepatocellular carcinoma and requires aggressive interventional management. Based on a review of published data and on personal experience with patients suffering from end-stage liver disease, I propose an algorithm for the evaluation and treatment of patients with cirrhosis and hemoperitoneum.
Abdominal Injuries↗
Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review.
Hemoperitoneum is a well-recognized, if uncommon, complication of chronic peritoneal dialysis. In this review of 424 patients maintained on peritoneal dialysis at a single center during an 11-year period, 26 patients (6.1%) developed one or more episodes of hemoperitoneum. Three patients had hemoperitoneum on two separate occasions with different etiologies. One additional patient was seen on a hospital consultative service. Three types of bleeding episodes were observed. Twenty-one of 30 (70%) were benign, consisting of pink-tinged dialysate with little clinical consequence (group 1). Three (10%) consisted of minor hemoperitoneum associated with significant intra-abdominal pathology (group 2), and six (20%) required active intervention (group 3). The most frequent cause of hemoperitoneum was bleeding related to menstruation or ovulation; hemoperitoneum was more common in women than in men. Two patients had hemoperitoneum occurring after more than 6 years on dialysis. In both, the etiology was sclerosing peritonitis, an association not previously noted. The less common etiologies of hemoperitoneum encountered in our patients were similar to those in reports from other centers and are compiled here.
Female↗
Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma.
PURPOSE: To determine, at screening ultrasonography, the prevalence, severity, and clinical outcome of clinically important abdominal visceral injuries, without associated hemoperitoneum, that result from blunt abdominal trauma. MATERIALS AND METHODS: Computed tomography (CT) was performed at admission in 466 patients with visceral injury. A retrospective review was performed of findings from surgery and contrast material-enhanced spiral and conventional CT performed to verify abdominal visceral injuries in 467 (4%) of 11,188 patients with blunt trauma. These patients were admitted to a level 1 trauma center over 33 months to determine the presence of hemoperitoneum and to identify the grade of injury. Medical records of patients with abdominal visceral injury without hemoperitoneum were reviewed for the management required and for results of focused abdominal sonography for trauma (FAST). RESULTS: A total of 575 abdominal visceral injuries were identified at CT and/or surgery. Findings of CT at admission (n = 156) and of surgery (n = 1) revealed no evidence of hemoperitoneum in 157 (34%) patients with abdominal visceral injury; 26 (17%) of whom also had negative FAST studies. Abdominal visceral injuries diagnosed in patients without hemoperitoneum included 57 (27%) of 210 splenic injuries, 71 (34%) of 206 hepatic injuries, 30 (48%) of 63 renal injuries, four (11%) of 35 mesenteric injuries, and two (29%) of seven pancreatic injuries. Surgical and/or angiographic intervention was required in 26 (17%) patients without hemoperitoneum. CONCLUSION: Reliance on the presence of hemoperitoneum as the sole indicator of abdominal visceral injury limits the value of FAST as a screening diagnostic modality for patients who sustain blunt abdominal trauma.
Abdominal Injuries↗
Hemoperitoneum in patients receiving hemodialysis.
Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. Hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. Hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. Hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain.
Abdominal Pain↗
Free echogenic pelvic fluid: correlation with hemoperitoneum.
Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.
Adolescent↗
[Neonatal hemoperitoneum: role of ultrasonography. Experience with 4 cases].
This study was aimed at investigating the role of US in the newborn with a clinical suspicion of hemoperitoneum. Hemoperitoneum is a dramatic clinical event which may be caused by some obstetrical and fetal factors--breech or complicated delivery, hepatomegaly, macrosomy, anoxic liver congestion being the most frequent causes. Direct or indirect trauma of an abdominal organ during delivery represents the major pathogenetic factor. Clinical symptoms are correlated with the appearance of shock whose intensity is proportional to trauma severity: symptoms may appear even 48 hours after delivery. The authors report their experience with 4 consecutive cases of neonatal hemoperitoneum which underwent US of the abdomen 24 to 72 hours after birth. In the first 3 newborns, US was performed on the basis of a clinical picture of bleeding shock, while in the extant newborn US was performed after a sudden increase in blood transaminase level associated with an obstetrical paralysis of the left arm. The US examinations were performed using a 7.5-MHz sectorial probe unit (Siemens). In all patients, US demonstrated the presence of a liquid effusion in the abdomen which could be referred to hemoperitoneum. In two patients, it was associated with a traumatic focal alteration of the liver parenchyma, in the third with a diffuse subcapsular liver hematoma and, finally in the fourth patient with a disconnected splenic vascular pedicle which was at surgery demonstrated. In conclusion, US is indicated as the most reliable and valuable diagnostic technique in the study of neonatal hemoperitoneum. The authors believe abdominal US to be essential in all the neonatal cases where hemoperitoneum is suspected and in selected cases presenting specific risk factors, to allow a rapid diagnosis and better treatment planning.
Hemoperitoneum↗
Acute hemoperitoneum in children: prevalence of low-attenuation fluid.
BACKGROUND: Recent evidence indicates that acute hemoperitoneum may have lower than expected attenuation values at CT. OBJECTIVE: To characterize the attenuation of acute hemoperitoneum at CT in children following blunt abdominal trauma and to assess the prevalence of low-attenuation fluid. MATERIALS AND METHODS: The CT scans of 19 consecutive children with isolated hepatic or splenic injury and associated peritoneal fluid were retrospectively analyzed. The attenuation value of peritoneal fluid was assessed in all peritoneal spaces. RESULTS: Fluid was noted in 53 peritoneal spaces (27 abdominal, 26 pelvic). Fluid attenuation ranged from 20 to 64 HU. The mean fluid attenuation in pelvic spaces (37.5 +/- 9.4 HU) was significantly lower than in abdominal spaces (444.9 +/- 10.2 HU) (P = 0.008). Fluid in 8/26 (31 %) pelvic spaces and 2/27 (7 %) abdominal spaces had attenuation values < or = 30 HU. Fluid surrounding the site of injury (perihepatic or perisplenic space) was significantly higher in attenuation than fluid at other sites (P < 0.001). There was no correlation between the mean attenuation value of peritoneal fluid in each patient and the admission hematocrit (r = -0.14, P = 0.55). CONCLUSIONS: There is great variability in the attenuation of acute hemoperitoneum. Blood in pelvic spaces has significantly lower attenuation than blood in abdominal spaces. Hemoperitoneum in the pelvis has values of < or = 30 HU in approximately one-third of spaces. The attenuation of acute hemoperitoneum does not correlate with hematocrit.
Abdominal Injuries↗
Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis.
BACKGROUND: To describe the spectrum of imaging findings and clinical presentations produced after rupture and hemorrhage of an ovarian cyst. METHODS: Imaging studies and hospital records of nine patients who were ultimately diagnosed with hemoperitoneum from a ruptured ovarian cyst were reviewed and categorized. RESULTS: Hemoperitoneum from a ruptured ovarian cyst presented a range of imaging findings. Although the imaging findings were dominated by hemoperitoneum, at least a vestige of the cyst could be identified in seven patients. The diagnosis of hemoperitoneum from a ruptured ovarian cyst was favored in only four of nine patients after the initial imaging study. CONCLUSIONS: A ruptured ovarian cyst can produce massive hemoperitoneum, with clinical symptomatology and sonographic features that closely mimic those of other disorders, in particular ectopic pregnancy. Considering the likelihood of both clinical and radiologic misdiagnosis, the radiologist should consider and pursue the diagnosis of a ruptured hemorrhagic ovarian cyst in a woman of child-bearing age who presents with pelvic pain and a large amount of complicated intraperitoneal fluid.
Adult↗
Hemoperitoneum in a continuous ambulatory peritoneal dialysis patient caused by a hepatocarcinoma treated with percutaneous embolization.
Hemoperitoneum is an infrequent but normally benign complication in continuous ambulatory peritoneal dialysis (CAPD) patients. It can occur at any time during peritoneal dialytic treatment. Hemoperitoneum is not associated with a specific disease and usually disappears spontaneously. In 20% of cases, however, hemoperitoneum is severe and requires specific investigation and emergency therapy. We report a case of hemoperitoneum in a 70-year-old, anti-hepatitic C virus-positive woman. After 48 months of CAPD treatment, a bloody peritoneal effluent developed, with severe anemia (hematocrit decreased from 30% to 20%). An abdominal computed tomography scan showed three hepatic lesions with signs of hepatic neoplasms; selective hepatic arteriography confirmed the diagnosis. Chemoembolization of the three lesions was performed, and hemoperitoneum disappeared within a few hours.
Aged↗
Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST)
BACKGROUND: Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. METHODS: Clinical, radiologic, and FAST data were collected prospectively on BTVs over a 12-month period. All patients with FAST-negative for hemoperitoneum were further analyzed. Examination findings and associated injuries were evaluated for association with abdominal lesions. RESULTS: Of 772 BTVs undergoing FAST, 52 (7%) had abdominal injury. Fifteen of 52 (29%) had no hemoperitoneum by admission computed tomographic scan, and all had FAST interpreted as negative. Four patients with splenic injury underwent laparotomy. Six other patients with splenic injury and five patients with hepatic injury were managed nonoperatively. Clinical risk factors significantly associated with abdominal injury in BTVs without hemoperitoneum include: abrasion, contusion, pain, or tenderness in the lower chest or upper abdomen; pulmonary contusion; lower rib fractures; hemo- or pneumothorax; hematuria; pelvic fracture; and thoracolumbar spine fracture. CONCLUSIONS: Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.
Abdominal Injuries↗
[Ultrasonographic finding of hemoperitoneum and indication for laparotomy in blunt abdominal trauma].
The usefulness of the ultrasonography (US) for the indication for laparotomy was evaluated. I analyzed 200 blunt trauma patients who took US exams at my emergency center immediately after admission. Ninety-five percent of patients with hemodynamic instability, whose hemoperitoneum was revealed by US, underwent laparotomy. No negative laparotomy was performed in those patients. Only 5.4% of US hemoperitoneum-negative patients with stable hemodynamics required laparotomy because of peritoneal irritation or the evidence of traumatic diaphragmatic hernia. US hemoperitoneum-positive patients with stable hemodynamics were treated selectively, and 46% of such patients eventually underwent laparotomy, depending on findings of serial US, CT, DPL and Intravenous urogram. In two third of them laparotomy was indicated because of serial US showing the appearance or increase in hemoperitoneum. The maximum width of echo free space in Morison's pouch became more than 10 mm in the all exams when the laparotomy was indicated. I believe that US finding of hemoperitoneum should be an integral part of evaluating laparotomy indications in blunt abdominal trauma.
Abdominal Injuries↗
Hemoperitoneum in a newborn secondary to antenatal hemorrhage into a retroperitoneal lymphangioma.
Hemoperitoneum in the newborn is an uncommon event, occurring most often in the setting of traumatic delivery. Hemoperitoneum resulting from antenatal hemorrhage into an abdominal mass is rare. We present a case of neonatal hemoperitoneum secondary to antenatal hemorrhage into a retroperitoneal lymphangioma. The differential diagnosis of neonatal hemoperitoneum is discussed.
Diagnosis, Differential↗
Hemoperitoneum as a first manifestation of hepatocellular carcinoma in western patients with liver cirrhosis: effectiveness of emergency treatment with transcatheter arterial embolization.
Hemoperitoneum is a well-known form of hepatocellular carcinoma presentation and represents a frequent complication in countries with a high incidence of hepatocellular carcinoma, but it is rarely seen in Western countries. Our aim was to report the results and describe the arteriographic and CT-scan characteristics in a series of seven consecutive patients. They were admitted to our hospital because of hemoperitoneum due to ruptured tumor as a first manifestation of hepatocellular carcinoma, and the rupture was effectively controlled by transcatheter arterial embolization. From April 1989 to April 1998, 440 consecutive patients were admitted to our liver unit with the diagnosis of hepatocellular carcinoma and liver cirrhosis. Fourteen patients (3%) presented with acute hemoperitoneum due to tumor rupture as a first manifestation of hepatocellular carcinoma. We here report our experience in the group of patients treated by transcatheter arterial embolization. Mean age was 67.1+/-5 years (range, 61-73). All patients presented with sudden abdominal pain, abdominal distension, and four patients had symptoms of acute anemia. In all cases the ruptured tumor was subcapsular. The procedure was effective in the control of bleeding in all cases, without significant impairment in liver function or treatment-related deaths. In six of the seven patients, a self-limited postembolization syndrome was observed. Mean survival time was 273+/-488.7 days (range: 15-1290). Three patients survived more than six months but at the time of evaluation, only one patient was alive. In conclusion, the present results confirm that transcatheter arterial embolization is an effective and well-tolerated treatment in the management of hemoperitoneum due to ruptured hepatocellular carcinoma in patients with liver cirrhosis.
Aged↗
Vital signs fail to correlate with hemoperitoneum from ruptured ectopic pregnancy.
The objective was to determine correlation between vital signs and hemoperitoneum in ruptured ectopic pregnancy. A retrospective chart review of ectopic pregnancies at our urban county hospital between 1990 and 1998 was conducted. Fifty-one cases met inclusion criteria. Mean minimum systolic blood pressure (SBP) 89mmHg (range 40-118), mean maximum heart rate (HR) 101 beats/min (range 62-156). Mean volume of hemoperitoneum 1,050 mL (range 400-2,000 mL). Correlation between vital signs and volume of hemoperitoneum was poor (R(2) = 0.04 for HR, R(2) = 0.1 for SBP). Association of tachycardia with hypotension was also poor (R(2) = 0.1). Extreme individual variations were observed. If surgical decisions were made on the basis of hypotension, 38% of patients could have received either inappropriate additional studies or surgical approach. Patients with normal vital signs had a 20% chance of having class IV blood loss at surgery. HR and blood pressure do not correlate well with volumes of hemoperitoneum from ruptured ectopic pregnancy.
Adult↗