Post mortem CT demonstration of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension.
In patients with liver cirrhosis and portal hypertension collateral circulation can develop to direct blood from portal to systemic veins allowing decompression of the portal system. A potential complication of portal hypertension is rupture of collateral vessels with subsequent fatal hemorrhage, occurring most commonly in the esophagus. The paraumbilical vein is a recognized collateral pathway in patients with portal hypertension however cases of rupture have been rarely documented. The authors report a case of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension. Post mortem CT imaging was valuable in localizing the source of hemorrhage in this case.
The Victorian Institute of Forensic Medicine, 57-83 Kavanagh St, Southbank, VIC, 3006, Australia. bott.eleanor@gmail.com
Eleanor
E
Bott
Christopher
C
O'Donnell
Michael
M
Burke
D000058:Accidental Falls; D001344:Autopsy; D002423:Cause of Death; D003097:Collateral Circulation; D017809:Fatal Outcome; D005554:Forensic Medicine / Q000379:methods*; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006554:Hernia, Umbilical / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D014471:Umbilical Veins / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology