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2015, Number 3

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Anales de Radiología México 2015; 14 (3)

Sectional imaging diagnosis of nontraumatic hemorrhagic acute abdomen

Motta-Ramírez GA, García-Verastegui LS, Valencia-Flores JA, Castillo-Lima JA, López-Ramírez MA, García-Ruiz A

Language: Spanish
References: 49
Page: 308-326
PDF size: 646.71 Kb.


ABSTRACT

Objective: Review the identification, behavior, and appearance of the hemoperitoneum by cross-sectional imaging (ultrasound and multidetector computed tomography) with emphasis on its origin, and identify factors which may contribute to timely identification and diagnosis of hemoperitoneum to reduce associated morbidity and mortality.
Material and methods: Ambispective, transverse analysis of a series of patients in whom hemoperitoneum was confirmed, over a period of 8 years 6 months.
Results: Forty-one (41) patients were se included, 27 women (66%) and 14 (34%) men, in an age range of 20 to 89 years. The diagnosis of non-traumatic hemorrhagic acute abdomen by cross-sectional imaging included 22 (53%) single phase tomographies, 2 (5%) tomographies with oral contrast, and 15 (42%) multiphase tomographies. The reason for tomographies, independently of technique, was as follow-up to surgical procedures: postoperative evaluation in 15 (42%); vascular compromise in 5 (12%) (which includes monitoring of aneurism of the abdominal aorta); monitoring of Balthazar grade C pancreatitis in 1 (2.5%); hypertensive disorder in pregnancy and puerperium; and HELLP syndrome in 1 (2.5%) and spontaneous in 2 (5%); with associated gynecological condition without defined adnexal disease in 1 (2.5%) and gynecological condition associated with adnexal compromise in 9 (22%). Also, intra-abdominal tumoral lesion predisposing to hemoperitoneum was confirmed in 7 (17%): 4 of hepatic, 2 of renal, and 1 of gastric origin. The tomography report, regardless of the technique used, identified hemoperitoneum in 93% of the patients.
Conclusions: Detection of hemoperitoneum by tomography is based on the fact that blood usually has a higher coefficient of attenuation than other bodily fluids. However, bleeding density may vary depending on various factors including evolution time, quantity, and location of blood. When hemoperitoneum is identified, if active extravasation is defined, it is indicative of the need for immediate intervention. Sentinel clot sign will be the clue to define the bleeding site. Hemoperitoneum should be detected by any image method and represents one more of the emergency situations detected aside from any clinical information. It is essential that radiologists be familiar with this ominous identifiable situation which predisposes an attitude of timely communication with the attending physician.


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