Blood in the Belly: CT Findings of Hemoperitoneum

Abstract

Hemoperitoneum may occur in various emergent conditions. In the trauma setting, evidence of intraperitoneal blood depicted at computed tomography (CT) should lead the radiologist to conduct a careful search of images for the injured visceral organ (the liver or spleen). Specific CT signs, such as a sentinel clot or extravasation of intravascular contrast material, may indicate the source of bleeding and help direct management. In addition, the configuration of accumulated blood may help identify the injured organ; for example, triangular fluid collections are observed in the mesentery most often in the setting of bowel or mesenteric injury. Less commonly, hemoperitoneum may have a nontraumatic origin. Iatrogenic hemoperitoneum may occur as a complication of surgery or other interventional procedures in the abdominal cavity or as a result of anticoagulation therapy. Hemoperitoneum also may be seen in the setting of blood dyscrasias such as hemophilia and polycythemia vera. Tumor-associated hemorrhage, which most often occurs in hepatocellular carcinoma, hepatic adenoma, or vascular metastatic disease, also may produce hemoperitoneum. Other potential causes of nontraumatic hemoperitoneum are gynecologic conditions such as hemorrhage or rupture of an ovarian cyst and rupture of the gestational sac in ectopic pregnancy, and hepatic hematoma in syndromic hemolysis with elevated liver enzymes and low platelet count (HELLP syndrome). Vascular lesions (visceral artery aneurysms and pseudoaneurysms) that occur in systemic vascular diseases such as Ehlers-Danlos syndrome or in pancreatitis are another less common source of hemoperitoneum.

Massive intra-abdominal bleeding caused by nontraumatic rupture of a vein in the colorenal ligament: Report of a case

“…1 Venous aneurysms or varices are a less common cause of intra-abdominal bleeding, and are usually associated with underlying portal hypertension in patients with liver cirrhosis. 3,4 There are several interesting aspects of this case: Although the patient had early-stage liver cirrhosis, undiagnosed before the emergency operation, there were no signs of portal hypertension such as obvious collaterals or dilated or varicose altered veins.…”

Ruptured intramural intestinal hematoma in an adolescent patient with severe hemophilia A

“…Thus, we were able to treat hematoma conservatively with favorable outcome. Although blood in the abdomen is usually considered a surgical emergency, there are numerous reports of successful nonsurgical management [12].…”

CT prediction of the degree of ovarian torsion

“…Two experienced radiologists, each with more than 5 years experience in body imaging, retrospectively reviewed the CT scan images for the presence or absence of nine CT findings suggesting ovarian torsion [7][8][9][10][11][12]. Radiologists were both unaware of the torsion angle and of surgical and pathological information except that all patients had surgery for ovarian torsion.…”

“…The third category included ancillary findings related to ovarian tumors and torsion, such as ascites and adipose tissue. Pelvic fluid with CT attenuation >30 HU was determined to be hemoperitoneum [10,11]. If there was infiltration of fat around the twisted mass, infiltration of pelvic fat was regarded as present [10].…”