Hemoperitoneum in dengue fever with normal coagulation profile

Abstract

A 43-year-old male living in Bengaluru sought emergency services due to high-grade fever, headache, myalgia, abdominal pain and distension. Platelet count (except the first-96,000/mm3) and coagulation profile was in normal limits. The dengue serology was positive for IgM and Ig G (immunoglobulin M and G) antibodies. Ultrasound abdomen showed gross ascites, mild bilateral pleural effusion and hepatosplenomegaly. The patient continued to have abdominal pain and progressive distention Ascitic tap was hemorrhagic. Later laparoscopy showed 1.5 liters peritoneal fluid with blood clots and mild diffuse congestion of the peritoneum. Liver, spleen and blood vessels were normal. Then what would be the possible mechanism to explain hemoperitoneum, is it the increased vascular permeability caused by the virus? India being endemic for dengue illness, it is an interesting and rare case presentation.

Corpus luteal cyst rupture presenting as massive spontaneous hemoperitoneum in women with dengue infection: A case series

“…2 In women with Dengue fever, associated thrombocytopenia further increases the chances of spontaneous hemoperitoneum in luteal phase of menstrual cycle. 6 Diagnosis may be difficult due to multiple conditions mimicking its presentation like acute appendicitis, rupture ectopic pregnancy, acute urinary tract infection etc. Prompt diagnosis (specially using ultrasound), negative urine pregnancy test, other blood biochemical investigations and eventually surgical management are mainstay of treatment.…”

“…Predisposing factors for the same are (a) hemoconcentration, (b) increased prothrombin time, (c) elevated alanine transaminase (ALT) and (d) platelet count of less than 50,000 cells/mm 3 . 6 In literature, There are few case reports of dengue illness with hemoperitoneum secondary to spontaneous rupture of the spleen. 6 corpus luteal cyst rupture has been discussed commonly as radiological differential diagnosis.…”

“…6 In literature, There are few case reports of dengue illness with hemoperitoneum secondary to spontaneous rupture of the spleen. 6 corpus luteal cyst rupture has been discussed commonly as radiological differential diagnosis. Only one case report is available in literature suggesting similar findings in a female with dengue infection thus leading us to a conclusion that corpus luteal cyst rupture associated with dengue infection is a rare entity.…”

Minimally Invasive Surgery in Dengue Patient

“…According to a recent report from Malaysia, Ng et al concluded that "early surgical intervention in perforated gastric ulcer is vital in preventing further complication and reducing the risk of mortality (7)." In case with suspicious hemoperitoneum due to dengue, the laparoscope approach is also reported as a safe diagnostic approach (8). In order to select a minimally invasive surgery in dengue patient, several considerations, especially patient's condition are important.…”