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Hemoperitoneum is the presence of blood in the peritoneal cavity, usually caused by organ rupture or trauma. Organs such as the gastrointestinal tract, reproductive tract, and blood vessels can be affected. Immediate surgery is required to locate the source of bleeding and prevent further damage.
Hemoperitoneum refers to the condition where there is blood in the peritoneal cavity. It is also called hematoperitoneum. Conditions with associated hemoperitoneum are considered medical emergencies because bleeding into the peritoneal cavity is indicative of organ rupture. Also, because blood is a toxic irritant to cells outside blood vessels, it needs to be cleaned out immediately. When there is blood in the peritoneal cavity, it usually manifests itself externally as a discoloration of the abdomen.
Several 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 found 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 are punctured, ruptured or subjected to trauma. For example, with penetrating or blunt trauma to the abdomen, the spleen or liver may be damaged. When mechanical damage occurs to these organs, blood infiltration becomes inevitable, leading to hematoperitoneum.
A common cause of hematoperitoneum in women is ectopic pregnancy. In an ectopic pregnancy, the embryo implants itself 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 ovaries. When the embryo overwhelms its blood supply and increases in size, rupture becomes imminent. After rupture, blood is poured into the cavity and causes hemoperitoneum.
Another reproductive organ that may 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 poured into the peritoneal cavity. A previous cesarean section is the most common predisposing factor to uterine rupture and subsequent hemoperitoneum.
Gastric ulcer perforation is a gastrointestinal cause of hemoperitoneum, although it is less common. The most common causes of gastric ulcers are persistently high levels of stomach acid and colonization of the gastric mucosa by the bacterium Helicobacter pylori. With an ulcer, there is an erosion of the mucous membrane. If this process is not stopped or healed, the erosion reaches the outer parts of the gastric tube and a hole is created. Blood vessels are also torn during drilling, so hemoperitoneum can follow.
When hemoperitoneum occurs, immediate surgery is done to locate the source of bleeding. If the spleen is heavily involved, it is removed through a procedure called a splenectomy. In cases where the liver is involved, surgeons may opt for sponge cleaning and administration of thrombin. If major abdominal arteries are involved, they are clamped and ligated. The blood is cleaned and blood coagulants are given to prevent further damage.
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