[Hemoperitoneum--how to proceed?]

This case report presents a patient with liver cirrhosis and hematoperitoneum. In about 5-15% of all patients with liver cirrhosis and ascites a hematoperitoneum is present. In most cases such intraperitoneal bleedings are asymptomatic and will be diagnosed only by diagnostic paracentesis of the ascites. Aside from rupture of intrahepatic tumors as origin of hemorrhagia or spontaneous bleeding out of varices other possible causes are discussed such as carcinomatosis of the peritoneum, spontaneous bacterial peritonitis and perforation of vessels due to diagnostic puncture. For a correct and complete diagnostic work-up it is important to gain as much ascites as possible and perform all relevant analyses including biochemical, cytological and hematological ones on the ascites. The incidence of iatrogenic bleeding due to punction of ascites and the therapeutic consequences of hematoperitoneum are discussed.