Obscure causes of intra-abdominal hemorrhage

1. 1. Spontaneous intra-abdominal hemorrhage results in findings characteristic of acute abdominal disease. 2. 2. Abdominal arteries, particularly the superior mesenteric, middle colic and celiac arteries and aorta may rupture, apparently spontaneously, and result in massive hemoperitoneum. This type of accident is often associated with hypertension, arteriosclerosis and less frequently with dissecting or luetic aneurysm. Such an occurrence is most commonly seen in males at the age of forty-five to fifty-five years. 3. 3. Minor injury and strain incited by vomiting or purging may initiate the rupture of a weakened vessel and influence the extent and course of the hemorrhage. 4. 4. Subserosal and mesenteric varices may rupture and lead to fatal hemoperitoneum. 5. 5. Numerous causes of hemoperitoneum (some easily diagnosed, others with great difficulty) must be differentiated. 6. 6. The signs and symptoms of hemoperitoneum are briefly discussed. 7. 7. The blood pressure may be normal early in the course of a patient with intra-abdominal bleeding depending on the rapidity of bleeding and volume of blood lost. 8. 8. When spontaneous hemoperitoneum is suspected, frequent blood pressure readings should be taken since the blood pressure fall may precipitously occur at variable periods after the onset of symptoms. 9. 9. Cases of hemoperitoneum, due to obscure causes, are reported.