Hemoperitoneum – Causes, Diagnostic Tests and Treatment
would mean the presence of blood in the abdominal cavity, essentially the peritoneal cavity. The peritoneal cavity is the space between the parietal peritoneum and the visceral peritoneum, the two membranes separating the abdominal organs from the abdominal wall. The peritoneal cavity is a fluid filled sac. The fluid acts as a lubricant reducing friction between organs and has protective anti inflammatory properties.
The condition discussed refers to a state when blood accumulates in the peritoneal cavity. The space between the inner lining of the abdominal wall and the abdominal organs would be filled with blood. The peritoneal cavity is quite distensible or like a stretchable sac and can hold up to 5 liters of blood. So blood leaking into the abdominal cavity has the potential of causing a massive blood loss and steer the body into a state of hemorrhagic shock and if untreated can lead to death.
Causes of hemoperitoneum
- Penetrating and deep abdominal trauma.
- Stabbing penetrating wound.
- Blunt trauma caused to the major abdominal organs like the liver or spleen.
- Spleen rupture.
- Spleen injury.
- Liver rupture.
- Bowel laceration.
- Aorta or any other vascular rupture like abdominal aortic aneurysym.
- Laceration of pancreas.
- Ectopic pregnancy and hemorrhage.
- Uterine rupture.
- Rupture of ovarian cyst.
- Perforated gastric ulcer.
- Disseminated intravascular coagulation or the formation of small blood clots in the blood vessels of the body which absorbs most of the coagulating proteins and platelets disturbing normal coagulation and causing abnormal bleeding.
- Rupture of cancerous mass or adenomas in the abdomen.
Diagnostic Tests to detect the abnormal bleeding
Focused Assessment with Sonography for Trauma (FAST)
: It is an emergency ultrasound performed by surgeons to detect the presence of blood in the peritoneal cavity post trauma, injury or rupture.
: The fluid accumulated in the peritoneal cavity, blood or otherwise is drawn out with the help of a needle and tested.
: A CT Scan of the abdomen would reveal the accumulation of fluid in the peritoneal space.
Diagnostic laproscopy or exploratory laparotomy
: A small incision is done in the abdomen and the blood in the peritoneum is drained out carefully without hurting the other organs. Symptoms of internal hemorrhage leads to this procedure which can be used both for diagnostic as well as treatment purposes.
Treatment of Hemoperitoneum
- Emergency surgery to locate the source of blood loss and arrest the blood loss is the primary line of treatment. The treatment is dependent on the underlying cause of the bleeding.
- Vascular hemorrhage causing blood loss involves ligation , clamping or tying off the bleeding vessel .
- Ruptured spleen causing bleeding mostly involves surgical removal of the spleen.
- Bleeding from the liver is controlled with coagulating agents like thrombin or other techniques of coagulation like argon beam cauterization.