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