title: Vaginal bleeding from massive hemoperitoneum. A case report.
abstract: BACKGROUND
  A gynecology service is often asked to consult and evaluate in-house patients with vaginal bleeding.
  
  
  METHODS
  A 31-year-old, Asian woman with a history of end-stage renal disease and hemodialysis was admitted to the hospital with a falling hematocrit. She subsequently began to have heavy vaginal bleeding. Computed tomography suggested a peritoneal-cervical fistula. Subsequent exploratory laparotomy documented that the bleeding was caused by retrograde flow of a hemoperitoneum.
  
  
  CONCLUSIONS
  This appears to be the first reported case of retrograde flow from a hemoperitoneum causing vaginal bleeding. Although unusual, this case expands the differential diagnosis when evaluating vaginal bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: P
authors.initials: P
authors.lastname: Marcus
authors.forename: G
authors.initials: G
authors.lastname: Raff
authors.forename: J
authors.initials: J
authors.lastname: Rothenberg
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006465:Hemoperitoneum / Q000150:complications* / Q000175:diagnosis*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D012720:Severity of Illness Index; D014621:Vagina