Suber W J, Cunningham P L, Bloch R S
Department of Surgery, Easton Hospital, Pennsylvania, USA.
Am Surg. 1998 Dec;64(12):1177-8.
Massive spontaneous hemoperitoneum has been infrequently presented in the literature. Only very seldom has this phenomenon been described without eventual discovery of an inciting event. We discuss a case of massive spontaneous hemoperitoneum in a 21-year-old healthy white male presenting with nausea, abdominal pain, and mild distention. There was a worsening in the degree of abdominal complaints since an initial evaluation by the Emergency Ward staff several hours before. The patient had no fever, vomiting, or other symptoms. He repeatedly denied trauma or memory of any potential precipitating event. The only pertinent laboratory finding was a drop in hemoglobin in the face of hemodynamic stability. Abdominal exploration revealed free intraperitoneal clotted blood without determination of definitive source of bleeding. No other abnormalities were found. A sound knowledge of potential causes of massive spontaneous hemoperitoneum in the nontraumatized patient with abdominal pain combined with a high index of suspicion and early operative intervention are keys to proper patient management.
大量自发性血腹在文献中鲜有报道。这种现象在最终未发现诱发事件的情况下极为罕见。我们讨论一例21岁健康白人男性的大量自发性血腹病例，该患者表现为恶心、腹痛和轻度腹胀。自急诊病房工作人员数小时前进行初次评估以来，腹部不适程度有所加重。患者无发热、呕吐或其他症状。他反复否认有外伤史或任何潜在诱发事件的记忆。唯一相关的实验室检查结果是在血流动力学稳定的情况下血红蛋白下降。腹部探查发现腹腔内有游离的凝血块，但未确定明确的出血来源。未发现其他异常。对于无外伤史但腹痛的患者，了解大量自发性血腹的潜在病因、保持高度怀疑以及早期手术干预是妥善管理患者的关键。
