title: Hemoperitoneum in a cirrhotic patient due to rupture of retroperitoneal varix.
abstract: The rupture of retroperitoneal varices is a rare and catastrophic complication of portal hypertension. We describe a case of this nature, the first in Brazilian medical literature, and also reviewing all previous 34 cases. We systematically analyzed all therapeutic approach and propose a management algorithm for diagnosis and treatment of this lethal condition. The majority of the patients presented with abdominal pain, distention and hypotension, and developed hemorrhagic shock. Rupture of retroperitoneal varices can be properly managed if an early diagnosis is made and surgery is performed promptly, which is the only effective treatment. Arteriography should be used when the suspicion is of rupture of hepatocellular carcinoma.
authors.affiliation: Department of General Surgery of Universitary Hospital and Clinics Hospital, University of São Paulo Medical School (FMUSP), 05403-000 São Paulo, SP, Brazil. igorsincos@gmail.com
authors.forename: Igor Rafael
authors.initials: IR
authors.lastname: Sincos
authors.forename: Grace
authors.initials: G
authors.lastname: Mulatti
authors.forename: Sheila
authors.initials: S
authors.lastname: Mulatti
authors.forename: Ilana Cristina
authors.initials: IC
authors.lastname: Sincos
authors.forename: Sergio Q
authors.initials: SQ
authors.lastname: Belczak
authors.forename: Valdir
authors.initials: V
authors.lastname: Zamboni
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D001803:Blood Transfusion; D001938:Brazil; D018450:Disease Progression; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis*; D007813:Laparotomy / Q000379:methods; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis; D011183:Postoperative Complications / Q000503:physiopathology; D012187:Retroperitoneal Space / Q000098:blood supply; D012422:Rupture, Spontaneous / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis / Q000601:surgery*