Hemoperitoneum Caused by Spontaneous Rupture of the Umbilical Vein in Cirrhosis

Abstract

line incision was performed. We found hemoperitoneum (4400 mL of blood-stained liquid) caused by active bleeding from the patent and dilated umbilical vein on its periumbilical portion. Bleeding was stopped by ligation at the site of rupture, and the rest of the vein was disconnected from the portal circulation by complete vessel transection and ligation near the liver. We observed intra-abdominal varices and a micronodular cirrhotic liver but no other sources of bleeding. The patient received intraoperative transfusion of 4 units of packed red blood cells, 500 mL of fresh frozen plasma, and 1 platelet unit and was transferred to the intensive care unit after surgery. The patient started oral feeding uneventfully, and no bleeding recurrence was observed. The patient was discharged home on the 17th postoperative day. Hemoperitoneum from the spontaneous rupture of the umbilical vein in patients with portal hypertension has been scarcely reported.1‐3 Its clinical picture is a patient who presents with sudden hypovolemic shock, prior complaint of a vague abdominal pain with or without abdominal distention, and absence of gastrointestinal bleeding signs. Computed tomography scan typically reveals a large repermeabilized umbilical vein and periumbilical contrast leak,3 but in unstable patients the diagnosis is suggested by paracentesis or diagnostic peritoneal lavage.1‐3 Emergent exploratory laparotomy with surgical control of the bleeding source is vital to save the patient’s life,1‐3