What is the management for hemoperitonium?

From the Guidelines

Management of hemoperitoneum requires a multidisciplinary approach, with the primary goal of controlling hemorrhage and maintaining hemodynamic stability, as outlined in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. The initial management includes a restricted volume replacement strategy with a target systolic blood pressure of 80-90 mmHg, employing crystalloids such as 0.9% NaCl or balanced crystalloid solutions, while avoiding hypotonic solutions like Ringer's lactate in patients with severe head trauma 1. Key considerations in the management of hemoperitoneum include:

• Fluid resuscitation and blood product administration to maintain hemodynamic stability
• Diagnostic evaluation with laboratory tests and imaging studies, such as FAST ultrasound or CT scan
• Immediate surgical exploration via laparotomy for hemodynamically unstable patients to identify and control bleeding sources
• Less invasive approaches like angioembolization or laparoscopy for stable patients
• Correction of coagulopathy with fresh frozen plasma, platelets, or tranexamic acid, as recommended in the guideline 1
• Ongoing monitoring of vital signs, urine output, and serial hemoglobin levels to detect continued bleeding The use of damage-control surgery, pelvic ring closure, and stabilisation may also be necessary in certain cases, as outlined in the guideline 1. Overall, the management of hemoperitoneum requires a tailored approach, taking into account the severity of bleeding, the underlying cause, and the patient's overall clinical condition, with the primary goal of reducing morbidity, mortality, and improving quality of life 1.

From the Research

Management of Hemoperitonium

The management of hemoperitonium involves several approaches, including:

• Hemodynamic stabilization with supportive measures to control the source of bleeding 2
• Angiographic embolization, which is usually the first choice, or open surgery to control the source of bleeding 2
• Other therapeutic options, such as transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO), or intraoperative radiofrequency (RF) ablation, depending on the underlying etiology of the hemoperitonium 2

Diagnostic Strategies

Diagnostic strategies for hemoperitonium include:

• Computed tomography (CT) scans to diagnose hemoperitonium and identify the source of bleeding 3
• Ultrasonography to estimate the amount of hemoperitoneum and assess the need for therapeutic laparotomy 4
• Scoring systems, such as the ultrasonography scoring system, to guide decision-making during resuscitation 4

Treatment Approaches

Treatment approaches for hemoperitonium vary depending on the patient's condition and the underlying etiology:

• Emergent exploratory laparotomy is recommended for hemodynamically unstable patients suspected of having hemoperitonium 3
• Nonoperative management may be undertaken successfully in hemodynamically stable patients with close observation 5
• Angioembolization or surgical intervention may be necessary for spontaneous hemoperitonium 6