Hemoperitoneum in a Cirrhotic Patient Due to Rupture of Retroperitoneal Varix

Abstract

The rupture of retroperitoneal varices is a rare and catastrophic complication of portal hypertension. We describe a case of this nature, the first in Brazilian medical literature, and also reviewing all previous 34 cases. We systematically analyzed all therapeutic approach and propose a management algorithm for diagnosis and treatment of this lethal condition. The majority of the patients presented with abdominal pain, distention and hypotension, and developed hemorrhagic shock. Rupture of retroperitoneal varices can be properly managed if an early diagnosis is made and surgery is performed promptly, which is the only effective treatment. Arteriography should be used when the suspicion is of rupture of hepatocellular carcinoma.

Massive intra-abdominal bleeding caused by nontraumatic rupture of a vein in the colorenal ligament: Report of a case

“…1 Venous aneurysms or varices are a less common cause of intra-abdominal bleeding, and are usually associated with underlying portal hypertension in patients with liver cirrhosis. 3,4 There are several interesting aspects of this case: Although the patient had early-stage liver cirrhosis, undiagnosed before the emergency operation, there were no signs of portal hypertension such as obvious collaterals or dilated or varicose altered veins. The rightsided colorenal ligament is a rarely described, yet frequently encountered anatomic structure that runs from the colon to the right kidney, covering the duodenal fl exure on its way.…”

“…The rupture of venous vessels in the abdominal cavity is a highly lethal complication of severe portal hypertension, with mortality rates of up to 65%. 4 Therefore, immediate emergency laparotomy is an important prognostic determinant. Survival rates correlate with the patient's hepatic function, the impact of the hemorrhagic shock, and the timing of surgical intervention.…”

Spontaneous hemoperitoneum, due to bleeding from retroperitoneal varices, in a cirrhotic patient: a case report

“…The initial clinical manifestations in cirrhotic patients with rupture of retroperitoneal varices and hemoperitoneum include pain, abdominal distension, light headedness and syncope, with hypotension being the cause of all these symptoms . As our patient was admitted to the ED unresponsive and in hemorrhagic shock, it was not possible to evaluate his symptoms.…”

Spinal Cord Schistosomiasis

“…Although none were seen with the angiogram, the study was purely arterial, and no venogram was performed. According to Sincos et al, 14 34 cases of intraperitoneal bleeding due to rupture of cirrhosisassociated varices have been reported up to 2009, with only 1 case involving a noncirrhotic patient. 14 Accordingly, a contributive role in our case for portal hypertension cannot be excluded entirely.…”