Hemoperitoneum

Hemoperitoneum refers to the presence of blood within the peritoneal cavity, the area that contains the abdominal organs. This condition can result from various causes, including trauma, ruptured ectopic pregnancy, splenic rupture, and complications from medical procedures. Hemoperitoneum is a potentially life-threatening condition that requires prompt medical attention to identify and treat the underlying cause.

Causes

Hemoperitoneum can be caused by several factors, which can be broadly classified into traumatic and non-traumatic origins.

Traumatic

Trauma is a common cause of hemoperitoneum, often resulting from:

• Blunt abdominal trauma, such as from a car accident or fall
• Penetrating trauma, such as stab or gunshot wounds

Non-Traumatic

Non-traumatic causes of hemoperitoneum include:

• Ruptured ectopic pregnancy, where a fertilized egg implants outside the uterus
• Splenic rupture, which can occur spontaneously or due to underlying conditions like mononucleosis or malaria
• Liver diseases, including hepatocellular carcinoma or liver metastasis
• Gynecological disorders, such as ovarian cyst rupture or endometriosis
• Complications from medical or surgical procedures

Symptoms

Symptoms of hemoperitoneum can vary depending on the amount of blood loss and the rate at which it occurs. Common symptoms include:

• Abdominal pain or tenderness
• Abdominal distension
• Signs of shock (e.g., low blood pressure, rapid heart rate, dizziness)
• Referred pain to the shoulder (Kehr's sign), indicating irritation of the diaphragm

Diagnosis

Diagnosis of hemoperitoneum involves a combination of clinical assessment and diagnostic tests, including:

• Physical examination, focusing on abdominal tenderness and signs of internal bleeding
• Ultrasound, which can quickly identify free fluid in the abdomen
• Computed tomography (CT) scan, offering detailed images of the abdominal organs and potential sources of bleeding
• Diagnostic peritoneal lavage (DPL) or Focused Assessment with Sonography for Trauma (FAST) in emergency settings

Treatment

Treatment of hemoperitoneum aims to stabilize the patient and address the underlying cause of bleeding. Initial management includes:

• Fluid resuscitation to maintain blood pressure and organ perfusion
• Blood transfusion if significant blood loss has occurred
• Surgery to repair the source of bleeding, which may involve laparotomy or laparoscopy
• In some cases, angiography with embolization may be used to control bleeding without open surgery

Prognosis

The prognosis of hemoperitoneum depends on the cause, the amount of blood loss, and the timeliness of treatment. Early detection and treatment are crucial for a favorable outcome.

Prevention

Preventing hemoperitoneum involves minimizing risk factors for the underlying causes, such as using seat belts to prevent injuries from car accidents and managing chronic liver diseases to prevent complications.