title: Hemoperitoneum in cirrhotic patients without abdominal trauma or tumor.
abstract: BACKGROUND
  Hemoperitoneum is associated with several emergency conditions and is especially evident when it occurs in patients with liver cirrhosis. This study aimed to assess the clinical characteristics of cirrhotic patients who did not have abdominal trauma or tumor but who developed hemoperitoneum.
  
  
  METHODS
  We reviewed the clinical records of 1276 consecutive cirrhotic patients with hemoperitoneum at our center between January 2007 and December 2009. Hemoperitoneum was confirmed by abdominal paracentesis.
  
  
  RESULTS
  Of the 1276 cirrhotic patients, 19 were found to have hemoperitoneum, but only 6 did not have abdominal trauma or tumor. The occurrence of spontaneous hemoperitoneum in the cirrhotic patients was therefore 0.5%. Hemoperitoneum can occur spontaneously in severely decompensated cirrhotic patients with intra-abdominal collateral vessels and high scores on the model for end-stage liver disease and Child-Pugh-Turcotte test. Most patients presented with abdominal distension, abdominal pain, increased abdominal girth and hemodynamic instability with a significant drop in the hemoglobin level. Three patients died of hemorrhagic shock within 24 hours, and the other 3 died of hepatic encephalopathy or spontaneous bacterial peritonitis after 5 to 10 days because of further decompensation of the liver.
  
  
  CONCLUSIONS
  Hemoperitoneum can occur in cirrhotic patients who do not have abdominal trauma or tumor. It mainly occurs in severely decompensated end-stage cirrhotic patients. Cirrhotic patients with hemoperitoneum have a poor prognosis.
authors.affiliation: Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China.
authors.forename: Yuan-Ji
authors.initials: YJ
authors.lastname: Ma
authors.forename: En-Qiang
authors.initials: EQ
authors.lastname: Chen
authors.forename: Jia-Jie
authors.initials: JJ
authors.lastname: Lu
authors.forename: Ming-Zhen
authors.initials: MZ
authors.lastname: Tan
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
mesh_terms: D000007:Abdominal Injuries; D000008:Abdominal Neoplasms; D000328:Adult; D002681:China / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006465:Hemoperitoneum / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D019152:Paracentesis / Q000379:methods*; D017082:Portal Pressure; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index