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Hemoperitoneum in patients receiving hemodialysis
A Stolz1, J Fourcade, A Klisnick
1Service de Néphrologie et Réanimation Médicale, CHU G. Montpied, Clermont-Ferrand Cedex, France. stolz@bichat.inserm.fr
Summary
Hemoperitoneum, or blood in the abdomen, is a rare cause of acute abdominal pain in chronic hemodialysis patients. This condition, often linked to organ lesions rather than gynecologic issues, requires consideration in diagnosis.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Pathology
Background:
- Acute abdominal pain in chronic hemodialysis patients often stems from common causes like pancreatitis or ulcers.
- Hemoperitoneum is a less frequent cause, typically associated with peritoneal dialysis, menses, or ovarian issues.
- Its occurrence in chronic hemodialysis patients as a primary diagnosis is seldom considered.
Observation:
- This report details three women under 50 on long-term hemodialysis presenting with acute abdominal pain and shock.
- Emergency laparotomy confirmed hemoperitoneum not related to gynecologic origins.
- Identified bleeding sources included hepatic amyloidosis, sclerosing peritonitis, and acute hemorrhagic pancreatitis.
Findings:
- Hemoperitoneum in hemodialysis patients can arise from underlying organ lesions, not just gynecologic factors.
- Coagulation abnormalities and anticoagulation therapy during hemodialysis may exacerbate bleeding.
- Diagnosis is challenging, potentially leading to underestimation of its incidence.
Implications:
- Hemoperitoneum should be considered in the differential diagnosis of acute abdominal pain in chronic hemodialysis patients.
- Early recognition and diagnosis are crucial for appropriate management.
- Further research may clarify the specific mechanisms and risk factors in this patient population.