Akriviadis E A
Fourth Medical Unit, University of Thessaloniki, Hippocration Hospital, Greece.
Am J Gastroenterol. 1997 Apr;92(4):567-75.
To review existing data on the pathophysiology and clinical presentation of hemoperitoneum in patients with ascites and to familiarize practicing clinicians who take care of such patients with the therapeutic options currently available for management of this complication.
Relevant English-language articles published between January 1988 and November 1996 were identified through MEDLINE search, using the key words "hemoperitoneum" and "ascites." Articles cited in the bibliographies of these articles were searched manually. Published papers that contained data on hemoperitoneum in general and on hemoperitoneum developing in patients with ascites were reviewed.
In patients with ascites, hemoperitoneum can develop spontaneously or can follow abdominal trauma and diagnostic or therapeutic procedures. Spontaneous bleeding into ascites usually develops insidiously and may not cause hemodynamic instability, even in patients with cirrhosis. Massive acute hemoperitoneum from a ruptured intraperitoneal varix is an unusual complication of portal hypertension requiring prompt surgical treatment. Acute hemoperitoneum develops in 5-15% of patients with hepatocellular carcinoma requiring transcatheter arterial embolization. Metastatic liver tumors cause bloody ascites infrequently; however, this is a common complication of ovarian carcinoma.
Hemoperitoneum is a severe complication in patients with ascites. When it develops spontaneously, it is usually related to the same disease process that caused the formation of ascites. Massive bloody ascites develops acutely after the rupture of intra-abdominal varices or hepatocellular carcinoma and requires aggressive interventional management. Based on a review of published data and on personal experience with patients suffering from end-stage liver disease, I propose an algorithm for the evaluation and treatment of patients with cirrhosis and hemoperitoneum.
回顾有关腹水患者腹腔积血的病理生理学和临床表现的现有数据，并使负责此类患者的执业临床医生熟悉目前可用于处理这一并发症的治疗选择。
通过MEDLINE检索，使用关键词“腹腔积血”和“腹水”，确定1988年1月至1996年11月间发表的相关英文文章。手动检索这些文章参考文献中引用的文章。对包含一般腹腔积血数据以及腹水患者发生腹腔积血的数据的已发表论文进行综述。
在腹水患者中，腹腔积血可自发发生，也可继发于腹部创伤以及诊断或治疗操作之后。腹水的自发性出血通常隐匿发生，即使在肝硬化患者中也可能不会引起血流动力学不稳定。腹膜内静脉曲张破裂导致的大量急性腹腔积血是门静脉高压的一种罕见并发症，需要及时进行手术治疗。5% - 15%需要经导管动脉栓塞治疗的肝细胞癌患者会发生急性腹腔积血。转移性肝肿瘤很少引起血性腹水；然而，这是卵巢癌的常见并发症。
腹腔积血是腹水患者的一种严重并发症。当它自发发生时，通常与导致腹水形成的相同疾病过程有关。腹腔内静脉曲张或肝细胞癌破裂后会急性发生大量血性腹水，需要积极的介入治疗。基于对已发表数据的综述以及对终末期肝病患者的个人经验，我提出了一种肝硬化合并腹腔积血患者的评估和治疗方案。
