MOFFITT MORNING REPORT PEARLS 1/20/17: Spontaneous Hemoperitoneum!

Thanks to Josh for presenting a conundrum this morning of a middle-aged man with pancreatitis who was hospitalized with a GI bleed and concomitantly found to have spontaneous hemoperitoneum, likely due to rupture of a gastric vessel!

*******************************************

Top Pearls:

  1. Spontaneous hemoperitoneum is rare, mostly in anticoagulated or coagulopathic patients.
  2. It is due to nontraumatic rupture of the liver, spleen, or abdominal vasculature, or gynecologic causes.
  3. Management is surgical or embolization.

*******************************************

Thanks to Harry for sending out this recent review of spontaneous hemoperitoneum:

http://dx.doi.org/10.1016/j.suc.2013.10.006

Spontaneous hemoperitoneum is blood in the abdomen due to a non-traumatic cause.

Can be rapidly fatal due to hypotension/extravasation or abdominal compartment syndrome.

CT with contrast is the modality of choice, but ultrasound can be helpful if too unstable for CT.

The liver is the most common non-gynecologic source due to benign and malignant liver masses.

**Pearl: Remember hepatic adenomas in pregnant women and women taking OCPs.

The spleen is second most common, due to infection and less often hematologic malignancy.

Vascular causes include aneurysms, pseudoaneurysms, or arterial dissection and rupture. The celiac, SMA, and renal arteries are most common, usually due to severe atherosclerosis or vasculitis.

**Pearl: Remember that in chronic pancreatitis, splenic vein thrombosis can mimic portal hypertension leading to abdominal varices in the absence of cirrhosis!

See this table from the review mentioned above:

Hemoperitoneum.png

Evernote: https://www.evernote.com/shard/s272/sh/a3c53e98-4db7-43e2-bb8f-7b6ab8df6bb6/d683189bf16c26d0b05c49636c67203f

Have a great day everyone!

Sammy

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s