Updated: 12/15/2021

Hemoperitoneum

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  • Snapshot
    • A 50-year-old man is brought to the emergency room after a motor vehicle accident. He is hemodynamically stable at that time; his blood pressure is 110/70 mmHg and pulse is 90/min. After the team ensures that his airway and breathing are secured, they note ecchymoses in the shape of a steering wheel and ecchymosis of the flanks. They obtain a focused assessment with sonography for trauma (FAST) and discover the presence of blood in the abdominal cavity. As they proceed with the examination, his blood pressure drops to 90/60 mmHg and is no longer responsive to fluid resuscitation. He is prepped emergently for a diagnostic laparotomy.
  • Introduction
    • Overview
      • hemoperitoneum describes the presence of blood within the peritoneal cavity, often secondary to trauma
        • treatment is typically an urgent laparotomy
  • Epidemiology
    • Subtypes
      • penetrating trauma
      • blunt abdominal trauma
        • splenic or hepatic injury
      • abdominal aortic aneurysm rupture
      • perforated gastric ulcer
      • disseminated intravascular coagulation
      • complications of abdominal surgery
  • etiology
    • Pathogenesis
      • mechanism
        • abdominal cavity has the potential to hold > 5 L of blood, which can accumulate quickly, resulting in rapid blood loss causing hemorrhagic shock
        • large volume of blood can accumulate before patients present with any significant symptoms
  • Presentation
    • Symptoms
      • common symptoms
        • lightheadedness
        • abdominal pain
    • Physical exam
      • inspection
        • hemorrhagic shock
          • hypotension
          • tachycardia
      • motion
        • tenderness to palpation
        • rebound tenderness
        • rigid abdomen
        • tenderness with percussion
  • Imaging
    • Focused assessment with sonography for trauma (FAST)
      • indication
        • rapid diagnosis of hemoperitoneum
        • may not determine source of hemorrhage
      • findings
        • blood in peritoneal cavity
    • Computed tomography
      • indications
        • detection of solid organ injury
        • can determine source of hemorrhage
        • hemodynamically stable patients
      • findings
        • solid organ injury
  • Studies
    • Serum labs
      • complete blood count
        • assess for need for transfusion
      • blood type and cross
    • Invasive studies
      • diagnostic peritoneal lavage (abdominal paracentesis)
        • indication
          • can rapidly determine presence of intraperitoneal blood
          • hemodynamically unstable patient in whom FAST exam may not be useful (i.e., obstructed views)
  • Differential
    • Ectopic pregnancy
      • key distinguishing factors
        • hemoperitoneum may not be seen on imaging
        • transvaginal ultrasound may reveal ectopic pregnancy
        • elevated beta-HCG
  • Treatment
    • Medical
      • blood transfusion
        • indications
          • hemorrhagic shock
      • supportive care
        • indications
          • all patients
    • Surgical
      • laparotomy
        • indications
          • signs of peritonitis
          • hemorrhagic shock
          • clinical decompensation
  • Complications
    • Death
  • Prognosis
    • Depends on etiology of hemoperitoneum and rapid diagnosis/treatment

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