Intrapartum Rupture of the Falciform Ligament and Umbilical Vein

Abstract

Intra-abdominal hemorrhage in the newborn is uncommon, but it must be considered in the first 48 hours of life in the infant with pallor, anemia, abdominal distension, and shock. The injured liver is the most common source of bleeding, with the spleen and kidney less often involved. In the case presented, the hallmarks of intra-abdominal hemorrhage were evident. Exploratory laparotomy revealed intraperitoneal bleeding emanating from the disruption of the umbilical vein and its enveloping falciform ligament. There was no other site of intra-abdominal bleeding and there were no intrinsic abnormalities of the umbilical cord or the placenta. Disruption of the intra-abdominal umbilical vein represented the sole source of intra-abdominal bleeding in this patient. The case is reported to document disruption of the intra-abdominal umbilical vein as a rare cause of neonatal hemoperitoneum.

Hemoperitoneum in a newborn secondary to antenatal hemorrhage into a retroperitoneal lymphangioma

“…Adrenal hemorrhage and rupture of the kidney are rare causes of massive bleeding [1]. Other reported causes include rupture of the falciform ligament and umbilical vein [2] and injury to the umbilical artery during catheterization [3]. Massive hemorrhage from an abdominal mass is rare in the neonate.…”

Manifestations of Birth Trauma at the Forensic Pediatric Autopsy

“…Intra-abdominal injuries are rare and manifest as lacerations or subcapsular hematomas of the liver or spleen, or adrenal hemorrhages, with liver injuries being the most common (64). Mechanisms include direct trauma to the abdomen, compression of the chest against the surface of the liver or spleen, or torso compression with tearing of the peritoneal support ligaments of the liver or spleen (65, 66). Presentation is variable, depending on the amount and rapidity of blood loss; signs and symptoms may be delayed with insidious loss of blood into the subcapsular space of the liver or spleen, with acute decline following rupture.…”

Neonatal Hemoperitoneum: Unexpected Birth Trauma with Fatal Consequences

“…Three potential mechanisms lead to intra-abdominal injury: 1- direct trauma; 2- compression of the chest against the surface of the spleen or liver; 3- chest compression leading to tearing of the ligamentous insertions of the liver or spleen. [ 2 3 ] Clinical symptoms are correlated with the appearance of shock, the intensity of which is proportional to the severity of the trauma. Especially in the first hour of life, the clinical signs of impending shock could be misunderstood or mistaken for asphyxia.…”