What is Hemoperitoneum?
Hemoperitoneum is a medical condition in which there is collection of blood in the abdominal cavity specifically the peritoneal cavity. The peritoneal cavity is the space between the two peritoneal membranes which separate the abdominal wall from the abdominal organs. It is basically a fluid filled sac. The fluid present in the peritoneal cavity acts as a lubricant to reduce friction between the organs and also has antiinflammatory properties.
Hemoperitoneum is caused when blood accumulates in the peritoneal cavity. This results in the inner lining of the abdominal wall and abdominal organs to be filled with blood. Usually, the peritoneal cavity has enough elasticity to accommodate up to 4 liters of blood.
Thus, if the blood seeps through the peritoneal cavity then it means there is massive blood loss and has the potential to move the body towards a state of hemorrhagic shock which at times can be fatal for the individual if it is left untreated as a result of Hemoperitoneum.
What Causes Hemoperitoneum?
Some of the causes of Hemoperitoneum are:
- An acute abdominal trauma or injury which may be deep and penetrating
- A stabbing injury to the abdominal area
- Blunt trauma caused as a result of an injury due to an assault or an act of violence can cause Hemoperitoneum
- Rupture or injury of the spleen
- Rupture of the liver
- Bowel laceration
- Rupture of abdominal aortic aneurysm.
- Ectopic pregnancy and hemorrhage
- Uterine rupture
- Rupture of ovarian cyst
What are the Symptoms of Hemoperitoneum?
In most cases of Hemoperitoneum, the patients remain asymptomatic for quite a few days after the initial injury that started the bleeding. It is only after a period of time that patients start to complain of abdominal discomfort and pain. The blood pressure of the individual may also be a bit low. The individual may become lethargic and may feel fatigued all the times. In acute cases of Hemoperitoneum, the blood loss may lead to hemorrhagic shock which can be quite dangerous and hence early diagnosis is recommended of Hemoperitoneum.
How is Hemoperitoneum Diagnosed?
Once an individual presents to the emergency room with an injury or trauma to the abdominal area, the first thing the emergency physician would do is to conduct an emergency ultrasound of the abdomen to look for presence of blood in the peritoneal cavity.
A paracentesis may also be performed to detect the presence of blood in the peritoneal cavity. Any fluid present in the peritoneal cavity whether it is blood or not is withdrawn through a needle and sent for analysis. A CT scan of the abdomen will be done which will reveal accumulation of fluid within the peritoneal cavity. These tests will confirm the diagnosis of Hemoperitoneum.
For diagnostic and therapeutic reasons, an exploratory laparotomy may be performed and blood will be drained from the peritoneal cavity to confirm the diagnosis of Hemoperitoneum.
How is Hemoperitoneum Treated?
Once Hemoperitoneum is diagnosed then the patient will have to undergo emergency surgery to identify the location of the blood loss and stop further blood loss from the area and treat Hemoperitoneum. Other treatments of Hemoperitoneum are dependent on the cause of the bleeding.
Bleeding caused by vascular hemorrhage can be taken care of by ligation or tying off the bleeding vessel. If a ruptured spleen is responsible for the bleeding then a splenectomy may need to be performed. If the source of the bleeding is the liver then coagulating agents may be used to stop the bleeding and treat Hemoperitoneum.