Hemoperitoneum refers to the condition when there is blood in the peritoneal cavity. It is also called hematoperitoneum. Conditions with associated hemoperitoneum are considered medical emergencies because the spillage of blood in the peritoneal cavity is indicative of organ rupture. Additionally, because blood is a toxic irritant to cells outside the blood vessels, it has to be cleaned up immediately. When there is blood in the peritoneal cavity, it usually manifests externally as a discoloration of the abdomen.
Different organs are contained within the peritoneal cavity. These organs include parts of the gastrointestinal tract such as the stomach, intestines, liver, spleen, and pancreas. Parts of the reproductive tract, such as the uterus, ovaries, and Fallopian tubes, are also located within the peritoneal cavity. Blood vessels, such as the celiac artery, superior mesenteric artery, and inferior mesenteric artery, provide most of the blood supply within the peritoneal cavity.
Hemoperitoneum occurs when any of the organs or blood vessels mentioned perforates, ruptures, or becomes subjected to trauma. For instance, with a penetrating or blunt trauma to the abdomen, the spleen or the liver can be injured. When mechanical damage occurs to these organs, blood seepage becomes inevitable, leading to hematoperitoneum.
A common cause of hematoperitoneum in women is ectopic pregnancy. In ectopic pregnancy, the embryo implants in parts of the female reproductive tract that are not ideal for growth and development. The most common sites of ectopic pregnancy are the Fallopian tubes and the ovaries. As the embryo overwhelms its blood supply and increases in size, rupture becomes imminent. Upon rupture, blood is spilled into the cavity and results in hemoperitoneum.
Another reproductive organ that could be affected by hematoperitoneum is the uterus, a strong muscular organ that has a rich blood supply. When it ruptures, a large amount of blood is spilled into the peritoneal cavity. A previous caesarean section is the most common predisposing factor of uterine rupture and subsequent hemoperitoneum.
Gastric ulcer perforation is a gastroenterology cause of hemoperitoneum, although it is less common. The most common causes of gastric ulcers are persistently high gastric acid levels and colonization of the gastric mucosa by the bacterium Helicobacter pylori. With an ulcer, there is an erosion of the mucosa. If this process is not arrested or healed, the erosion reaches the outer parts of the gastric tube and a hole is created. Blood vessels are also torn during perforation, so hemoperitoneum can follow.
When hemoperitoneum occurs, immediate surgery is done to locate the bleeding source. If the spleen is greatly involved, it is removed through a procedure called splenectomy. In cases where the liver is involved, the surgeons may opt to do sponge cleanup and thrombin administration. If major abdominal arteries are involved, these are clamped and ligated. The blood is cleaned and blood coagulants are given to prevent further damage.