Bleeding in the abdominal cavity

Disease Description (Causes and Symptoms)

• Definition: Intraperitoneal bleeding is a condition in which blood accumulates within the peritoneal cavity (the space surrounded by the peritoneum and containing intra-abdominal organs such as the stomach, intestines, liver, spleen, pancreas, and kidneys).
• Main causes
  • Rupture of organs (such as the spleen or liver) or blood vessels due to trauma
  • Ruptured aneurysm (such as an abdominal aortic aneurysm)
  • Gynecological causes: ectopic pregnancy (ruptured fallopian tube), ovarian bleeding, etc.
  • Tumor rupture (such as liver cancer) or bleeding accompanied by gastrointestinal perforation
  • Minor bleeding may worsen when anticoagulant use or a bleeding disorder is present as an underlying factor
• Pathophysiology: Accumulation of blood in the peritoneal cavity causes decreased blood volume → tachycardia and hypotension (hypovolemic shock), along with symptoms of peritoneal irritation. Blood irritation may cause pain, abdominal distension, rebound tenderness, and other symptoms.
• Main symptoms
  • Abdominal pain, tenderness, and abdominal distension
  • Tachycardia (rapid pulse), hypotension, dizziness, and risk of fainting
  • Pallor, cold skin (hypothermia and cold sweats), and difficulty breathing
  • If bleeding progresses slowly, symptoms may appear several days to several weeks after an initially asymptomatic period

Treatment Methods

• Initial emergency care (priority for all patients)
  • Secure ABCs (airway, breathing, and circulation) and provide oxygen
  • Establish intravenous access, rapidly administer fluids (crystalloids), and provide transfusions (blood and blood products) if necessary
  • Monitor vital signs and urine output (using a urinary catheter)
• Treatment principles according to diagnostic classification
  • Hemodynamically unstable patients (hypotension or signs of ongoing bleeding): Emergency surgery (laparotomy or, when appropriate, laparotomy and hemostasis) is required
  • Hemodynamically stable patients: After identifying the bleeding source through imaging (contrast-enhanced abdominal CT), consider conservative treatment or vascular embolization (arterial embolization)
• Specific treatment methods
  • Surgical treatment: Hemostasis and resection through laparotomy or laparoscopy (removal or repair of the ruptured organ)
  • Nonsurgical treatment: Depending on severity in traumatic bleeding of the liver, spleen, and other organs, observation (hemodynamic monitoring) and vascular embolization to occlude the blood vessel
  • Gynecological emergencies (ectopic pregnancy and ovarian bleeding): Emergency laparotomy (or laparoscopy depending on the patient’s condition)
  • Conservative treatment: Administration of packed red blood cells, fresh frozen plasma, and other products according to transfusion guidelines; correction of coagulation abnormalities (vitamin K, prothrombin complex concentrates, etc., when necessary)
• Lifestyle management and precautions
  • Because this is an emergency, home treatment is not possible — go to the emergency room immediately if bleeding is suspected
  • Immediately inform medical staff if taking anticoagulants or antiplatelet agents
  • After stabilization, treat the underlying cause and prevent rebleeding (aneurysm treatment, tumor management, etc.)
• Possible complications
  • Hypovolemic shock, multiorgan failure, peritonitis, intraperitoneal empyema and infection, intestinal obstruction caused by intra-abdominal scarring and adhesions, increased intra-abdominal pressure (abdominal compartment syndrome), and persistent anemia

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring
  • A list of all medications currently being taken (especially anticoagulants, antiplatelet agents, and anticancer drugs) or the medication packages
  • Medical history: bleeding disorders, liver disease, recent trauma, and surgical history (especially abdominal surgery)
  • Recent test results (blood tests, ultrasound, CT, etc.) and, if available, the original imaging data or a CD
  • A record of when symptoms began and how they have changed (when they started, whether they have worsened or improved, and related events)
  • Possibility of pregnancy or current pregnancy status (women)
• Things to check before the outpatient visit
  • Vital signs (recent temperature, pulse, and blood pressure if possible)
  • Changes in urine output (such as decreased daily urine volume)
  • Other bleeding-related symptoms (bloody stool, vomiting blood, vaginal bleeding, etc.)
• Sample questions (items for the patient to ask or prepare)
  • Briefly summarize when the symptoms began and how they have progressed
  • Prepare to ask whether anticoagulants or antiplatelet agents being taken should be stopped and how to stop them

Examples of General Questions to Ask the Doctor

• "Given my current condition, is emergency surgery necessary? Is nonsurgical treatment possible?"
• "What are the criteria for a blood transfusion, such as the hemoglobin level?"
• "What are the risks of complications during and after treatment, and what signs should I watch for?"
• "How long will hospitalization last, and how long is recovery expected to take?"
• "When and how should I restart my usual medications, especially anticoagulants?"

Examples of Condition-Specific Questions

• "If the cause of my bleeding is (for example, an ectopic pregnancy, liver tumor, abdominal aortic aneurysm, or ruptured spleen), what additional tests or treatment are needed to assess and prevent the risk of recurrence?"
• "If I choose nonsurgical management (vascular embolization or observation), what is the probability of rebleeding, and how often should follow-up tests (CT/ultrasound) be performed?"

Additional information: Intraperitoneal bleeding may be an emergency. If bleeding is suspected, it is important to visit an emergency medical institution without delay for prompt evaluation and treatment.