Hemoperitoneum in cirrhotic patients in the absence of abdominal trauma

Expert Rev Gastroenterol Hepatol. 2019 Sep;13(9):867-876. doi: 10.1080/17474124.2019.1631159. Epub 2019 Jun 17.

Abstract

Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and optimal management. Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and potential novel targets are reported and discussed. Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures and to control the source of bleeding. The latter can be achieved with angiographic embolization, which is usually the first choice, or with open surgery. Other therapeutic options according to specific etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra operative radio frequency (RF).

Keywords: Cirrhosis; ectopic varices; emergency TIPS; non-traumatic hemoperitoneum; retroperitoneal bleeding; ruptured Hepatocellular Carcinoma (HCC); splenic artery aneurism; spontaneous hemoperitoneum; trans arterial embolization (TAE).

Publication types

  • Review

MeSH terms

  • Abdominal Injuries / complications
  • Hemoperitoneum / etiology*
  • Humans
  • Liver Cirrhosis / complications*