Spontaneous hemopneumothorax simulating acute abdominal affections

Abstract

Spontaneous hemopneumothorax (SHP) is a rare potentially life-threatening condition that occurs in predominantly young adolescents. The resultant massive hemorrhage leading to hypovolemic shock can be a surgical emergency. It constitutes 1-12% of all spontaneous pneumothoraces and presents with two cardinal features, chest pain and dyspnea. However, the pain of SHP may be confined to the abdomen secondary to the irritation of diaphragmatic pleura, which produces signs simulating an acute abdomen. SHP masquerading as an abdominal affection is apparently regarded as extremely rare. We present a case of a 16-year-old male with SHP presenting features simulating acute gallbladder disease. After prompt diagnosis with appropriate surgical intervention, he had an uneventful recovery. Our experience emphasizes the importance of careful and thorough chest examination for each child with atypical pictures for abdominal pain to exclude possible extra-abdominal lesions, even rare as SHP.

Spontaneous hemopneumothorax after laparoscopy: a case report and literature review

“…In contrast, conservative treatment may result in hypovolemic shock secondary to massive hemorrhage with a mortality rate of up to 33%. 14 However, research has shown that it is difficult to determine the source of bleeding in patients with SHP, especially during the initial VATS procedure. 15 This may be because the collapsed lung loses its local filling ability, and blood from even small vessels can freely flow into the chest cavity, resulting in a large amount of blood loss and hemorrhagic shock.…”

Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

“…Abdominal rigidity is probably produced by basal pleurisy. Besides the simulation of gallbladder disease [36], SHP may also simulate appendicitis, bleeding peptic ulcer, or even perforated peptic ulcer.…”