Massive spontaneous hemoperitoneum of unknown etiology: a case report

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.