Spontaneous Intra-abdominal Hemorrhage Research Articles

Idiopathic Spontaneous Intra-Abdominal Hemorrhage or Abdominal Apoplexy: A Rare Cause of Abdominal Pain.

Idiopathic spontaneous intra-abdominal hemorrhage (ISIH) is a rare condition that can be catastrophic if not diagnosed and treated promptly. Herein, we report a case of ISIH due to suspected hemorrhage of the proximal branch of the superior mesenteric artery, which caused epigastric pain.

Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non-neoplastic causes.

Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.

Overview of spontaneous intraabdominal tumor hemorrhage: etiologies, imaging findings, and management.

Hemorrhage is a potential complication of benign and malignant tumors and tumor-like conditions in the abdomen. Patients often have non-specific presentations, although they may present critically ill and hemodynamically unstable. Imaging plays an important role not only in the diagnosis of hemorrhage but also in the detection and characterization of an underlying mass. Ultrasound, computed tomography, and magnetic resonance imaging are utilized in evaluating these patients, with each having particular strengths and limitations. Spontaneous tumor hemorrhage is most commonly seen in hepatic and renal lesions, although it can arise from nearly every abdominal organ. In this article, we will review principles of tumor hemorrhage, illustrate common and uncommon imaging features, and highlight different options for management.

An unusual presentation of pancreatic serous cystadenoma

Pancreatic cystic neoplasms (PCNs) are predominantly benign entities which represent almost 50 percent of all cystic lesions of the pancreas. PCNs are often an incidental finding on abdominal imaging and are not indicated for surgical resection unless they show evidence of malignant transformation or become symptomatic due to mass effect. This report examines an unusual presentation of a PCN, in a 70 years old female with sudden onset abdominal pain, who was found to have spontaneous intraabdominal haemorrhage secondary to a benign PCN. Emergency laparotomy was performed and a distal pancreatectomy or splenectomy were required to achieve haemostasis. Incidence of spontaneous haemorrhage in a benign PCN is a rare but serious complication.

Spontaneous abdominal hemorrhage due to warfarin treatment

Warfarin is an anticoagulant used in the prevention of thromboembolism. Common clinical indications for warfarin use are atrial fibrillation, artificial heart valves, deep venous thrombosis. Common side effect of warfarin is hemorrhage. Intra-peritoneal hemorrhage is one of the complications, usually following trauma. We report spontaneous intra-abdominal hemorrhage secondary to warfarin therapy. A 79 year-old male patient was admitted to emergency clinic with the complaints of one day duration of abdominal pain. There was no history of trauma. He had been on warfarin for the prophylaxis of atrial fibrillation.The diagnosis of the spontaneous intra-abdominal bleeding secondary to warfarin was made and the patient was admitted internal medicine inpatient clinic.This case provides a learning lesson to the physicians to consider this rare but significant complication of warfarin in the differential diagnosis of all the cases of abdominal pain in patients who are on warfarin therapy.

Spontaneous omental bleeding in a 20-year old patient with hemophilia A

Spontaneous intraabdominal hemorrhage is a very rare event even in patients with bleeding disorders like hemophilia. Nevertheless this rare case must be considered in patients with coagulopathies presenting with abdominal pain. Prompt radiologic imaging and surgical consultation are of highest priority. Here we report on a 20-year-old patient with moderate hemophilia A, who underwent emergency laparotomy for a spontaneous idiopathic bleeding of the omentum majus. There are few cases in the literature on this sort of event in patients with hemophilia, who mostly suffer from spontaneous joint bleedings. These patients require an intensive, interdisciplinary perioperative care, involving haematologists, surgeons, radiologists and anesthesists. Finally we discuss, whether an optimized, individually adapted treatment with coagulation factors might possibly have prevented this bleeding event in this patient.

Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease.

Letter to the editor: spontaneous renal haemorrhage in end-stage renal disease.

Radiological diagnosis and management of idiopathic spontaneous intra-abdominal haemorrhage (abdominal apoplexy): a case series.

Idiopathic spontaneous intraperitoneal haemorrhage (ISIH), historically known as abdominal apoplexy, is spontaneous haemorrhage due to rupture of an intra-abdominal visceral vessel in the absence of trauma or underlying pathology. It is an exceptionally rare condition, with mostly scattered case reports available. The aim of this study was to describe this rare condition, possible associated risk factors, and usefulness of multislice-CT (MS-CT) angiogram in its diagnosis prior to intervention. A retrospective review of patients diagnosed with ISIH. Radiological records of haemoperitoneum from a single tertiary hospital in 2006-2013 were analysed, and the cases of ISIH were identified. Demographics (including pre-morbid hypertension status), abdominal aortic calcification as a measure of atherosclerotic changes, MS-CT angiogram +/- conventional digital subtraction angiograph images, surgical records and outcomes were reviewed. 425 cases of haemoperitoneum were retrieved from hospital radiology database from 2006 to 2013, and 5 patients (1.1%) diagnosed with ISIH were identified (4 males, 1 female, mean age of 64years). 4 out of 5 patients (80%) had a history of hypertension (mean 150/90mmHg) and 3 patients had moderate abdominal aortic atherosclerosis. MS-CT angiogram was able to diagnose the bleeding source in 4 out of 5 patients, while the bleeding source remained occult in the last patient even with both MS-CT and traditional DSA angiography. Patients who underwent either embolization or surgery had no further re-bleeding in clinical follow up, ranging from 5 to 8years. Hypertension and abdominal aortic atherosclerosis appear to be associated risk factors for ISIH, and MS-CT angiogram has a high sensitivity in detecting the site of haemorrhage. An integrated angiographic and surgical approach is important in managing patients with ISIH.

Spontaneous intra-abdominal bleed following oral anticoagulant therapy

With expanding avenues of oral anti-coagulant (OAC) use, the complications associated with it are also increasing. The incidence of hemorrhagic complications following oral anticoagulation varies between 3 and 48%.1,2 Spontaneous intra-abdominal hemorrhage associated with oral anticoagulant may present as an acute abdominal condition. The earliest such case was reported in 1953.3 Bleeding may occur into the lumen, wall or mesentery of the bowel, retroperitoneum, into or from solid viscera and into abdominal wall.4 We report a case of spontaneous mesenteric hematoma with adjacent small bowel gangrene in a patient on oral anticoagulation.

Rare postpartum ruptured degenerated fibroid: A case report

Spontaneous rupture of uterine fibroid is rarely encountered. We present a case of a 31-year-old who presented with acute abdominal pain at 9 weeks postpartum. On examination, the abdomen had diffuse tenderness, with rebound tenderness in the suprapubic area and in both iliac fossae. On ultrasonography, a 12.7 × 8.6 × 8.9-cm sized hyperechoic mass was visible on the posterior wall of the uterus. A large amount of fluid was visible in the paracolic gutters and the Pouch of Douglas (POD). The patient underwent an exploratory laparotomy. A ruptured, cystic degenerated uterine fibroid with active bleeding was found, as well as approximately half a liter of free, bloodstained peritoneal fluid and pus. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature

Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable.

Spontaneous mesenteric hemorrhage

Spontaneous intra-abdominal hemorrhage or abdominal apoplexy is an acute abdominal emergency which can exhibit a wide spectrum of clinical presentation. With the expanding avenues for anticoagulation therapy, this condition is becoming commoner. The association of this condition with antiplatelet therapy is less well established. We present a case of spontaneous mesenteric hematomas causing intestinal obstruction in a patient on antiplatelet therapy for ischemic heart disease. A review of etiology, clinical presentation and protocol of management is also presented. A high index of suspicion on the part of the clinician is essential to ensure a favorable outcome in this condition.

Idiopathic spontaneous haemoperitoneum due to a ruptured middle colic artery aneurysm

IntroductionIdiopathic spontaneous intra-abdominal haemorrhage is a rare, but challenging condition, associated with high mortality if not managed appropriately. The preoperative diagnosis is difficult, despite the recent advances in imaging. We present the clinical manifestations of this condition, as well as the available diagnostic and therapeutic modalities. Presentation of caseWe report a case of a spontaneously ruptured dissecting aneurysm of the middle colic artery, which was managed with an emergency laparotomy and aneurysmatectomy. Interestingly, no evidence of vasculitis, infection or collagen disease was discovered during the histopathology examination of the specimen. DiscussionThe treatment of idiopathic spontaneous intra-abdominal haemorrhage revolves around patient resuscitation and management of the source of bleeding. In case of a ruptured aneurysm of the middle colic artery, the surgical management includes emergency laparotomy, arterial ligation and resection of the aneurysm. Transarterial embolisation has been suggested as a safe and less invasive alternative approach. ConclusionA ruptured middle colic artery aneurysm should be included in the differential diagnosis of any unexplained intra-abdominal haemorrhage. Aneurysmatectomy is the treatment of choice, with radiologic interventional techniques gaining ground in the management of this entity.

A rare cause of spontaneous intra-abdominal haemorrhage due to coeliac artery stenosis.

Coeliac artery stenosis is associated with the formation of collateral vessels from the superior mesenteric artery. High pressure within collateral vessels can lead to the formation of visceral artery aneurysms. Haemorrhage from such aneurysms can be catastrophic if they are not identified and managed promptly. We describe successful arterial embolisation of a pseudoaneurysm arising from a branch of the gastroduodenal artery secondary to coeliac artery stenosis. To the best of our knowledge this is thefirst such reported case in the literature.

Intraabdominal hemorrhage during combined coronary artery bypass and carotid endarterectomy

Intraabdominal complications during cardiopulmonary bypass are extremely rare, with an incidence of less than 1% in multiple retrospective studies. These complications are associated with a high mortality, and their rapid diagnosis is critical to the outcome of the patient. We present a case of spontaneous intraabdominal hemorrhage after combined carotid endarterectomy and four-vessel coronary artery bypass grafting, which was diagnosed through a diaphragmatic window.

Spontaneous intraabdominal haemorrhage caused by segmental mediolytic arteritis in a patient with systemic lupus erythematosus—an underestimated entity of autoimmune origin?

We describe the sixth known case of segmental mediolytic arteritis and the third in a survivor. A 70-year-old woman had intraabdominal bleeding due to a ruptured aneurysm of the omental artery. Interestingly, this patient also had a systemic lupus erythematosus. This report gives further support to the role of immune abnormalities underlying segmental mediolytic arteritis.

Intra-abdominal Bleeding as a Result of Segmental Mediolytic Arteritis of an Omental Artery: Case Report

A seventy-three-year-old woman with intra-abdominal bleeding secondary to a ruptured omental artery was operated on successfully. Preoperatively an emergency angiogram showed patchy areas of narrowing and beading in the affected artery. The pathologic finding in the ruptured omental artery was segmental mediolytic arteritis, characterized by segmental disruption of the medial smooth muscle cells and the initiation of mediolysis. The authors report this rare case of spontaneous intra-abdominal hemorrhage.

Abdominal apoplexy: Report of six cases and review of the literature

Summary Massive spontaneous intra-abdominal hemorrhage (abdominal apoplexy) is an important mesenteric vascular catastrophe most often seen in elderly hypertensive and arteriosclerotic persons, although it may result from congenital vascular defects in younger patients, especially young women who are prone to rupture during pregnancy. The cause appears to be local disease of the mesenteric vessels such as defects in fusion of the medial coat or atheromatous ulcers with weakness and/or aneurysmal formation, coupled with increased intravascular pressure. Although multiple sources of bleeding have been reported, the branches of the celiac and superior mesenteric arteries are the most common sites of rupture. This may be followed by the production of either a large intramesenteric hematoma or an immediate massive hemoperitoneum. Initial bleeding may produce abdominal, back, shoulder, or testicular pain, shock, and signs of peritoneal irritation. Improvement for a varying time may then be followed by a secondary and usually massive episode of bleeding which is almost invariably fatal without prompt surgical intervention. Early operation with ligation of the bleeding point offers an excellent chance for recovery. It is believed that the diagnosis of massive intra-abdominal hemorrhage may be made more often if only the possibility were kept in mind. This diagnosis should be suspected in any patient with sudden severe abdominal pain, shock, signs of peritoneal irritation, and a falling hemoglobin or hematocrit, especially if hypertension, arteriosclerosis, or pregnancy is present. When abdominal apoplexy is strongly suspected, laparotomy should be performed immediately.

The Surgical Significance of Spontaneous Intra-abdominal Hemorrhage

The Surgical Significance of Spontaneous Intra-abdominal Hemorrhage

Obscure causes of intra-abdominal hemorrhage

1. 1. Spontaneous intra-abdominal hemorrhage results in findings characteristic of acute abdominal disease. 2. 2. Abdominal arteries, particularly the superior mesenteric, middle colic and celiac arteries and aorta may rupture, apparently spontaneously, and result in massive hemoperitoneum. This type of accident is often associated with hypertension, arteriosclerosis and less frequently with dissecting or luetic aneurysm. Such an occurrence is most commonly seen in males at the age of forty-five to fifty-five years. 3. 3. Minor injury and strain incited by vomiting or purging may initiate the rupture of a weakened vessel and influence the extent and course of the hemorrhage. 4. 4. Subserosal and mesenteric varices may rupture and lead to fatal hemoperitoneum. 5. 5. Numerous causes of hemoperitoneum (some easily diagnosed, others with great difficulty) must be differentiated. 6. 6. The signs and symptoms of hemoperitoneum are briefly discussed. 7. 7. The blood pressure may be normal early in the course of a patient with intra-abdominal bleeding depending on the rapidity of bleeding and volume of blood lost. 8. 8. When spontaneous hemoperitoneum is suspected, frequent blood pressure readings should be taken since the blood pressure fall may precipitously occur at variable periods after the onset of symptoms. 9. 9. Cases of hemoperitoneum, due to obscure causes, are reported.