Intra-abdominal hemorrhage from ruptured varices

Three patients with Laënnec's cirrhosis were initially seen with anemia, abdominal pain, and increased abdominal girth. Hemoperitoneum was diagnosed by paracentesis, and laparotomy revealed ruptured intraperitoneal varices. The two patients with more severe depletion died. The other patient, who was initially normotensive but had orthostatic changes, survived. A review of 11 previously reported cases is presented. Abdominal pain, hypotension, and increased abdominal girth were common initial findings, and should lead to early abdominal paracentesis. Suture ligation of the bleeding varix gives the greatest likelihood of survival.