Intraperitoneal Bleeding from Uncommon Causes
Intraperitoneal bleeding is infrequently caused by conditions other than ruptured abdominal aneurysm and ectopic pregnancy. In patients with the rarer causes of intraperitoneal bleeding, signs and symptoms referable to the specific bleeding lesion are generally absent, and the lesion is usually diagnosed during operation. Presenting features prompting surgical intervention are blood loss and peritoneal irritation; loss of circulating blood volume produces varying degrees of palor, tachycardia, hypotension, cold clammy skin, dyspenia, neurologic deficits, and altered sensorium. Features of peritonitis are produced by the extravasated blood. Pain of peritoneal irritation may be sudden or gradual in onset; it may be localized, diffuse, or referred to the shoulder. Likewise tenderness may be localized or generalized, but abdominal rigidity usually is not prominent. The features of blood loss and of peritoneal irritation depend on the suddenness and the severity of the hemorrhage; systemic features predominate when bleeding is sudden and profuse, overshadowing the features of peritoneal irritation. In contrast, slow and scanty hemorrhage is associated with little or no systemic changes, and the features of peritoneal irritation predominate in clinical presentation. In either event, the catastrophic nature of the problem should be recognized so the patient can be transferred to the operating room for prompt control of bleeding and for resuscitation.
KeywordsArtery Aneurysm Focal Nodular Hyperplasia Spontaneous Rupture Splenic Rupture Circulate Blood Volume
Unable to display preview. Download preview PDF.
- 4.Catalano PIN, Early ME, Topolosky HW, Martin EW, Jr, Carey LC (1977) Focal nodular hyperplasia of the liver: report of six patients. Concepts of surgical management. Cancer 39: 587Google Scholar
- 7.Orloff MJ, Peskin GW (1958) Spontaneous ruptures of normal spleen: a surgical enigma ( Mt abstr ). Surg Gynecol Obstet 106: 1Google Scholar