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What Is Hemoperitoneum?

Medically Reviewed by Melinda Ratini, DO, MS on June 02, 2021

Hemoperitoneum, sometimes also called intra-abdominal hemorrhage or intraperitoneal hemorrhage, is a type of internal bleeding in which blood gathers in your peritoneal cavity. This is the space between your organs and the inner lining of your abdominal wall. It can be caused by many different things, but it is a serious condition that needs immediate treatment.  

Types of Hemoperitoneum

There are three types of hemoperitoneum.

Traumatic hemoperitoneum. This condition is what happens when an injury or accident causes bleeding into your peritoneum. It is the most common cause of hemoperitoneum.

Nontraumatic hemoperitoneum. This type is what happens when other health conditions cause bleeding in your abdomen. This is sometimes called spontaneous hemoperitoneum. ‌

Iatrogenic hemoperitoneum. This type is a complication of surgery or procedures and some medications that cause bleeding into your abdomen. 

Causes of Hemoperitoneum

There are many causes of hemoperitoneum. In traumatic hemoperitoneum, a blunt trauma or a penetrating injury can damage your organs, usually your liver or spleen. 

Blunt traumas are injuries from contact with an object, like being hit or falling. This can cause organ damage and bleeding. Sometimes the blood collects inside the organ, but it doesn’t bleed into your abdomen right away. In this case, the organ and blood vessels can eventually rupture or burst and then bleed into your abdomen. This means that sometimes hemoperitoneum doesn’t happen right after an injury.

Penetrating injuries happen when an object enters your body. Some injuries are minor ones to the surface layers of your skin, but major injuries cause bleeding right away. This can lead to massive bleeding and shock.

Traumatic hemoperitoneum can be caused by:

  • Falling from heights
  • Car accidents
  • Direct blows to your abdomen, like kicks
  • Falling onto objects, like falling on handlebars
  • Sports contact
  • Stabbings
  • Gunshots

Nontraumatic hemoperitoneum is caused by other health conditions. These include: 

  • Ectopic pregnancy rupture
  • Ovarian cyst rupture
  • Rupture of a liver hematoma caused by hemolysis, elevated liver enzymes, lower platement syndrome, or HELLP syndrome
  • Hemophilia
  • Polycythemia vera
  • Artery aneurysm in the liver, kidney, or spleen
  • Bleeding from tumors
  • Endometriosis

Ectopic pregnancy is a common cause of nontraumatic hemoperitoneum. This happens when a fetus begins to grow somewhere other than your uterus. The ectopic pregnancy ruptures and can cause bleeding into the abdomen.‌

Iatrogenic hemoperitoneum happens after surgery. Sometimes even a low-risk surgery can cause bleeding into your abdomen after the procedure. This is a complication of your treatment. 

Some blood-thinning medications, like heparin or coumadin, can also cause bleeding. These side effects are also a type of iatrogenic hemoperitoneum.

Hemoperitoneum Symptoms

It’s sometimes hard to tell if you have hemoperitoneum unless you’ve had an injury or accident. Symptoms might also be different depending on the cause. 

In general, blood gathering in your abdomen means you’re losing blood from important organs and could quickly go into shock.

Symptoms can include:

  • Swollen belly
  • Fast heartbeat
  • Cold skin
  • Clammy skin
  • Sweating
  • Fast breathing
  • Pale or bluish skin
  • Confusion
  • Pain 

Ectopic pregnancy rupture, ovarian cyst ruptures, or endometriosis that causes hemoperitoneum can cause pain in your abdomen and pelvic area. 

If you’ve been in an accident or been hurt, you might have a lot of pain. Pain that radiates into your left shoulder is a sign of spleen damage.

Hemoperitoneum Diagnosis

If your doctor thinks you’re bleeding, they will move quickly to diagnose you. Your doctor will do a physical exam and imaging, which can include an ultrasound or a computed tomography (CT) scan. ‌

A paracentesis is another method of checking for peritoneal blood. This involves placing a needle into your abdomen and drawing out the fluids for testing.

In an emergency, your doctor might also use a technique called Focused Assessment with Sonography in Trauma, or FAST. This involves a sonogram of your abdomen and organs to check where blood tends to gather. 

Hemoperitoneum Treatment

The treatment for hemoperitoneum depends on the cause. ‌

Surgery. In some cases, your organs or blood vessels may need to be repaired. Your doctor might do surgery to block or fix a blood vessel, to remove a ruptured spleen, or to fix other problems.

Laparoscopic surgery. If you have an ectopic pregnancy or ovarian cyst, you might have a laparoscopic procedure to remove it and repair any tissues.

Medications. Your doctor might give you medications to help stop the bleeding. 

Blood transfusion. If you lose a lot of blood, you might need a transfusion to replenish your blood. 

Considerations for Hemoperitoneum

Hemoperitoneum is a life-threatening medical emergency, and you need treatment right away. Once you’ve been successfully treated, the outlook is good and you can fully recover. 

If you have any signs of internal bleeding, go to the hospital or call for emergency help right away. 

WebMD Medical Reference

Sources

SOURCES:

Current Problems in Diagnostic Radiology: “Spontaneous hemoperitoneum: causes and significance.”

Journal of Medical Case Reports: “Endometriosis-induced massive hemoperitoneum misdiagnosed as ruptured ectopic pregnancy: a case report.”

Medscape: “Focused Assessment with Sonography in Trauma (FAST): Practice Essentials, Technique, Preparation,” “Splenic Rupture.”

Merck Manuals Consumer Version: “Ectopic Pregnancy,” “Overview of Abdominal Injuries,” "Paracentesis." 

Mondie, C., Maguire, N., Rentea, R. Retroperitoneal Hematoma, StatPearls Publishing, 2021.

RadioGraphics: “Blood in the Belly: CT Findings of Hemoperitoneum.”

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