Portal hypertension presenting with haemoperitoneum.

Ross, Alison

doi:10.1136/bmj.1.5695.544

Cited by 16 publications

(4 citation statements)

References 3 publications

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“…We have observed that patients with cirrhosis and hemorrhagic ascites have a poor outcome. Few studies have evaluated hemorrhagic ascites or hemoperitoneum in non-critical care settings, with most of the available literature being case reports or small case series [3,5–12]. Thus, here, we have hypothesized that patients with hemorrhagic ascites have unique clinical features and perhaps poorer outcomes than commonly believed.…”

Section: Introductionmentioning

confidence: 97%

Hemorrhagic ascites. Clinical presentation and outcomes in patients with cirrhosis

Urrunaga¹,

Singal

Cuthbert

et al. 2013

Journal of Hepatology

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Background & Aims Hemorrhagic ascites can pose diagnostic and therapeutic dilemmas in patients with cirrhosis. We aimed at exploring the characteristics and outcomes of patients with cirrhosis and hemorrhagic ascites. Methods The records of all patients with cirrhosis and ascites, who underwent paracentesis between 2003 and 2010 at Parkland Memorial Hospital, were retrospectively reviewed. Hemorrhagic ascites was defined as an ascitic fluid red blood cell (RBC) count ≥10,000/μl. We compared each patient with 3 age- and gender-matched controls (cirrhotic patients with ascites and an ascitic RBC count <10,000/μl). Survival curves were generated using Kaplan–Meier plots and compared using the log rank test. Results 1113 cirrhotic patients underwent paracentesis; 214 (19%) had hemorrhagic ascites. Patients with hemorrhagic ascites had higher rates of spontaneous bacterial peritonitis (p <0.001), acute kidney injury (AKI, p <0.001), and were more likely to require intensive care unit (ICU)-level care (p = 0.01) compared to patients without hemorrhagic ascites. Patients with hemorrhagic ascites had a higher mortality than controls at one month (87% vs. 72%), 1 year (72% vs. 50%) and 3 years (61% vs. 41%). Using multivariate regression analysis, hemorrhagic ascites was also an independent predictor of mortality (HR 1.34, 95% CI 1.07–1.68) after adjusting for the model for end-stage liver disease score (HR 1.04, 1.03–1.05), ICU-level care (HR 2.02, 1.63–2.51) and presence of hepatocellular carcinoma (HR 2.27, 1.61–3.19). Conclusions Patients with hemorrhagic ascites had a significantly higher rate of ICU care, AKI, and mortality than patients with portal hypertension and ascites but without hemorrhagic ascites. We conclude that hemorrhagic ascites is a marker of advanced liver disease and poor outcome.

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Section: Introductionmentioning

confidence: 97%

Hemorrhagic ascites. Clinical presentation and outcomes in patients with cirrhosis

Urrunaga¹,

Singal

Cuthbert

et al. 2013

Journal of Hepatology

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“…The paracentesis was important in the diagnosis and surgical indication is most of the cases. Only two cases out of ten who survived did not undergo the paracentesis [ 5 , 6 ]. In one of them, the diagnosis was suggested via tomography and confirmed at laparotomy [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Hemoperitoneum in a Cirrhotic Patient Due to Rupture of Retroperitoneal Varix

Sincos

Mulatti

et al. 2009

HPB Surgery

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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.

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“…In spite of the presence of large quantities of intraperitoneal blood, the coma quickly resolved with blood transfusions and intra-venous bicarbonate therapy and it therefore seems likely that this marked acidosis played an important part in the precipitation of the hepatic coma. The intraperitoneal haemorrhage which was the cause of the hypotensive episode is surprisingly rare in portal hypertension, with only one case previously reported from a ruptured varix (Ross, 1970).…”

Section: Discussionmentioning

confidence: 99%

Primary biliary cirrhosis in brothers

Bown

Clark

Doniach

1975

Postgraduate Medical Journal

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Summary This is the first report of two brothers who demonstrated the classical clinical course, histology, biochemistry and auto-antibodies of primary biliary cirrhosis. Both also exhibited an associated keratoconjunctivitis sicca and, in one, renal tubular acidosis resulted in severe systemic acidosis after lactulose therapy and with a subsequent intraperitoneal variceal rupture. Screening of the relatives recalled a high incidence of ‘auto-immune’ disease and auto-antibodies.

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Portal hypertension presenting with haemoperitoneum.

Cited by 16 publications

References 3 publications

Hemorrhagic ascites. Clinical presentation and outcomes in patients with cirrhosis

Hemorrhagic ascites. Clinical presentation and outcomes in patients with cirrhosis

Hemoperitoneum in a Cirrhotic Patient Due to Rupture of Retroperitoneal Varix

Primary biliary cirrhosis in brothers

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