Differential Diagnosis for Intrabdominal Hemorrhage

Single Most Likely Diagnosis

• Blunt abdominal trauma: This is often the most common cause of intrabdominal hemorrhage, especially in the context of motor vehicle accidents or falls. The force of the trauma can cause rupture of abdominal organs such as the spleen or liver, leading to significant bleeding.

Other Likely Diagnoses

• Ruptured abdominal aortic aneurysm: This condition involves the sudden tearing of the aorta, which can lead to massive intrabdominal bleeding. It is more common in older adults with a history of hypertension or smoking.
• Peptic ulcer disease: Bleeding from ulcers in the stomach or duodenum can lead to intrabdominal hemorrhage, especially if the ulcer erodes into a major blood vessel.
• Ectopic pregnancy: In pregnant women, a ruptured ectopic pregnancy can cause significant intrabdominal bleeding due to the implantation of the embryo outside the uterus, often in the fallopian tube.

Do Not Miss Diagnoses

• Ruptured ovarian cyst: Although less common, a ruptured ovarian cyst can cause sudden and severe intrabdominal bleeding, particularly in women of reproductive age.
• Hemorrhagic pancreatitis: Inflammation of the pancreas can lead to erosion into nearby blood vessels, resulting in intrabdominal hemorrhage.
• Trauma from invasive medical procedures: Complications from procedures like liver biopsies or angiographic interventions can cause intrabdominal bleeding.

Rare Diagnoses

• Vascular malformations: Rare congenital conditions like arteriovenous malformations can cause intrabdominal hemorrhage if they rupture.
• Tumors: Both primary and metastatic tumors in the abdomen can erode into blood vessels, leading to bleeding. Examples include hepatocellular carcinoma or metastatic disease to the liver or spleen.
• Infectious causes: Certain infections, such as a ruptured hepatic abscess, can lead to intrabdominal hemorrhage, although this is relatively rare in comparison to other causes.