Hemoperitoneum

What is hemoperitoneum?

Hemoperitoneum is bleeding within your peritoneal cavity, the space that contains your abdominal and pelvic organs. Hemo means blood, and peritoneum is the membrane that lines your peritoneal cavity. Internal bleeding (hemorrhage) within this space is a serious condition that requires urgent medical attention. Other names for it include intraperitoneal hemorrhage and intra-abdominal hemorrhage.

Why is hemoperitoneum serious?

When blood leaks from its normal pathways, your organs and tissues get less of it. Losing a lot of blood can have serious consequences, and it’s hard to tell how much or how fast you’re losing blood when it’s on the inside. This is especially true within your peritoneal cavity, because it can hold a lot of blood. If bleeding in this space continues without intervention, it could lead to life-threatening blood loss.

What are the symptoms of hemoperitoneum?

Symptoms of hemoperitoneum can vary depending on the cause. You might have acute abdominal pain or pelvic pain, but some causes are less painful than others. You might also notice your abdomen is distended (swollen) or tender to the touch. As bleeding continues, you'll begin to develop symptoms of serious blood loss. You might feel dizzy, weak or nauseous. You might notice your heart rate speed up.

What are the causes of hemoperitoneum?

There are many possible causes of hemoperitoneum, though some are more common than others. Healthcare providers categorize the possible causes as either traumatic, spontaneous or iatrogenic. Traumatic injuries and ectopic pregnancies are among the most common causes of hemoperitoneum.

Traumatic hemoperitoneum

Traumatic hemoperitoneum is the result of an injury to one of the organs or blood vessels in your peritoneal cavity. Most often, it’s your liver or spleen, organs that are known to bleed a lot. Traumatic injury can be blunt, from a hard impact, or penetrating, from something entering your body.

Causes include:

• Falls.
• Car accidents.
• Sports contact.
• Direct blows.
• Stab wounds.
• Gunshot wounds.

Spontaneous hemoperitoneum

Spontaneous or nontraumatic hemoperitoneum is bleeding that's not related to an injury. A disease or other organic process causes it. Sometimes an organ or blood vessel ruptures (breaks) from the inside, due to internal swelling or a preexisting wound. Abnormal tissue growths in your abdomen may also bleed.

Causes include:

• Ruptured aneurysm.
• Ruptured arteriovenous malformation (AVM).
• Ruptured gastrointestinal varices.
• Ruptured hematoma.
• Ruptured tumors.
• Ruptured ovarian cyst.
• Ruptured ectopic pregnancy.
• Spontaneous splenic rupture.
• Gastrointestinal perforation.
• Perforated gallbladder.
• Hemorrhagic pancreatitis.

Iatrogenic hemoperitoneum

Iatrogenic hemoperitoneum occurs as a side effect of a medical procedure. It’s rare, but it can happen if a procedure accidentally injures one of your organs or blood vessels. Examples of procedures include:

• Abdominal surgeries, like laparoscopy, organ removal or cesarean section delivery.
• Biopsy procedures, like a liver biopsy or kidney biopsy.
• Procedures to place a catheter through your abdomen, like PEG or paracentesis.
• Endoscopy procedures, like an upper endoscopy or colonoscopy.

What causes hemoperitoneum in someone assigned female at birth?

Female reproductive organs occupy the peritoneal cavity, and they may be involved in intraperitoneal bleeding. Ruptured ovarian cysts and ectopic pregnancies are two examples. Pregnancy itself can raise your risk of hemoperitoneum in a few ways. Certain liver tumors that can rupture tend to grow faster during pregnancy. You could also have a spontaneous or iatrogenic injury during labor or delivery.

Spontaneous hemoperitoneum in pregnancy

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare phenomenon in which spontaneous hemoperitoneum occurs during the second or third trimester of pregnancy, for unclear reasons. Most cases involve a ruptured blood vessel, though healthcare providers aren’t sure why the rupture occurs. Some evidence suggests that it may be related to preexisting endometriosis and/or in vitro fertilization.

What are other risk factors for hemoperitoneum?

You might be more prone to hemorrhage in general if you have a bleeding disorder or blood clotting deficiency. You might bleed spontaneously or bleed in response to a minor injury that wouldn’t usually be serious, and it might be more rapid than it would otherwise. Certain chronic diseases and conditions can lead to spontaneous hemoperitoneum if they progress to a rupture, although this isn’t common.

What are the possible complications of hemoperitoneum?

Bleeding in your abdominal cavity is significant because it’s internal and can become severe before you realize it. Complications develop when you lose too much blood too fast. How much blood you lose, and how fast, will depend on the original injury or cause, how fast you bleed in general, and how fast you get treatment. Severe blood loss can lead to hypovolemic shock, which can lead to organ failure and death.

What tests are used to diagnose hemoperitoneum?

If you have internal bleeding, a speedy diagnosis is important. When healthcare providers need to see what’s going on inside you urgently, they'll usually start with a quick imaging test, like an ultrasound or a CT scan. A FAST ultrasound is a focused bedside exam that looks specifically for evidence of internal bleeding in your peritoneal cavity. FAST stands for Focused Assessment with Sonography for Trauma.

Healthcare providers can often diagnose hemoperitoneum and identify the source of the bleeding on imaging tests. But in some cases, the imaging might not be clear enough. They might need to draw a sample of the fluid in your abdomen through a needle or catheter (paracentesis). If you’re in critical condition, they might put you immediately into exploratory surgery to find and fix the problem at once.

What is the treatment for hemoperitoneum?

Once your healthcare provider has diagnosed hemoperitoneum, they’ll look to find the source of the bleeding and whether it’s still active or not. If it is, they’ll want to stop it right away. How they do this will depend on your condition. If it’s urgent, you might need emergency surgery to repair a wound or seal a blood vessel. If your condition is stable, you might only need conservative management.

Treatment might include:

• Pain management.
• Blood transfusion.
• Evacuation (drainage) of fluids.
• Treatment for an underlying condition.
• Embolization to stop a bleeding vessel.
• Endoscopic interventions to seal a wound.
• Exploratory laparoscopy and/or laparoscopic surgical repair.
• Exploratory laparotomy and/or open surgical repair.

What is the outlook for hemoperitoneum?

Your prognosis will depend on how fast you get treatment, and how fast you’re bleeding. Your condition might be more urgent if you have a bleeding disorder or another chronic condition that affects your overall health status. Seeking care as soon as possible will help to prevent the complications that can come with severe blood loss. If you can avoid those complications, you're likely to make a full recovery.

A note from Cleveland Clinic

Hemoperitoneum is an acute condition that develops suddenly and unexpectedly. If you’ve had an injury, you might already be in medical care. But if you haven’t, you might not know what’s going on when symptoms develop. It’s important to take your symptoms seriously and seek care before your condition becomes more urgent. With timely diagnosis and treatment, your prognosis is good.