title: Fatally idiopathic spontaneous hemoperitoneum in a patient with cervical spine injury: a case report and review of the literature.
abstract: OBJECTIVE
  Idiopathic spontaneous hemoperitoneum has never been reported in patients with associated orthopedic injury. The present report aimed to demonstrate a case of this life-threatening condition concomitant with cervical spine injury.
  
  
  METHODS
  A 50-year-old male was an illegal immigrant and transferred to the emergency department with the conditions of the bilateral facet subluxation of C5-6 spine, including incomplete cord lesion (American-Spinal-lnjury-Association: grade-C) and without associated injury, caused by falling from a 3-meters-scaffold He underwent anterior cervical discectomy, fusion with iliac bone graft, and plating of C5-6 level at 20-hours after injury His overall conditions recovered gradually with the same neurological deficit as pre-operative status. On postoperative day 15, he developed acute hemodynamic instability and cardiac arrest in an hour without preceding signs. Autopsy showed free intra-peritoneal blood 1000 ml and fresh blood in gastric lumen-small bowels 500 ml without definitive source of bleeding.
  
  
  CONCLUSIONS
  The patient in this present report had no complaint of preceding abdominal symptoms in both pre-and-postoperative periods. His visceral sensibility might be lost due to incomplete cord lesion. At this point, he might have an incompetency of detection of intra-abdominal abnormality when it occurred Hence, this patient had no classic symptoms of spontaneous hemoperitoneum. This made the diagnosis of this condition quite difficult in the presented patient. This situation was very uncommon and essentially unique.
  
  
  CONCLUSIONS
  The authors recommend "high index of suspicion" of this diagnosis as a cause of hemodynamic instability in patients with neurological deficit, due to spine injury or any cause, which might prevent them to recognize antecedent abdominal symptoms.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat Hospital, Thammasat University, Pathum Thani, Thailand.
authors.forename: Chayanin
authors.initials: C
authors.lastname: Angthong
authors.forename: Thanet
authors.initials: T
authors.lastname: Watthanaapisith
authors.forename: Cholavech
authors.initials: C
authors.lastname: Chavasiri
mesh_terms: D001344:Autopsy; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D017586:Diskectomy; D017809:Fatal Outcome; D006465:Hemoperitoneum / Q000150:complications / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016103:Spinal Fractures / Q000473:pathology* / Q000601:surgery