Idiopathic spontaneous intraperitoneal haemorrhage: A near fatal presentation of acute abdomen requiring prompt diagnosis

Badri, Danniel; Killoran, Callie; Aseervatham, Ratna

doi:10.1016/j.ijscr.2023.108650

Cited by 1 publication

(2 citation statements)

References 9 publications

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“…We did not perform contrast-enhanced CT to search for the source of bleeding, avoiding radiation exposure to the fetus and some adverse effects of the contrast agent. Some investigators have reported that, if clinical status permits, CT angiogram scans can serve as a sensitive and specific tool for diagnosing and identifying sites of hemorrhage or pseudoaneurysm in the case of idiopathic spontaneous intraabdominal hemorrhage [10,12]. However, venous bleeding from the uterine surface, as in this case, may not have been detected using dynamic CT.…”

Section: Discussionmentioning

confidence: 93%

“…The time of onset was the second trimester and the clinical course of the case resembled that of our case. Although understandable, any pregnant or postpartum woman with severe abdominal pain, progressive anemia, and hypovolemic shock should be evaluated with care, and consideration should be given to the potential diagnosis of idiopathic spontaneous intraperitoneal hemorrhage [9,10]. Typically, cardiotocographic monitoring is not initiated until 22 weeks of gestation.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Hemoperitoneum in Pregnancy Due to Endometriosis in the Second Trimester

Ikagawa,

Inagaki,

Maeda

et al. 2024

J Clin Gynecol Obstet

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Spontaneous hemoperitoneum in pregnancy (SHiP) is defined as unprovoked intraperitoneal bleeding during pregnancy or up to 42 days postpartum. A 31-year-old primigravid woman presented to our hospital at 19 weeks of gestation with acute left lower abdominal pain. Upon several examinations, she was found to have intraabdominal bleeding. However, pelvic magnetic resonance imaging (MRI) failed to yield specific findings. The following day, owing to increased pain and progressive anemia, she underwent an exploratory laparotomy. Preoperative ultrasound imaging revealed intrauterine fetal death. Laparotomy revealed oozing-type active bleeding from three delicate tissues related to endometriosis: the myometrium at the uterine anterior and posterior surfaces and a portion of the peritoneum in the vesicouterine excavation. A cesarean section was performed, successfully halting the bleeding and obviating the need for a hysterectomy. She was ultimately diagnosed with SHiP. SHiP in the second trimester is relatively uncommon, and the subacute progression of symptoms made early diagnosis challenging. For a correct diagnosis and appropriate treatments, full consideration of the clinical circumstance is needed without excessive reliance on imaging findings, including MRI, and an early exploratory laparotomy may be the best approach in cases of an unclear source of bleeding.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%