Idiopathic spontaneous intraperitoneal haemorrhage: A near fatal presentation of acute abdomen requiring prompt diagnosis

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INTRODUCTION AND IMPORTANCE: Idiopathic spontaneous intraperitoneal haemorrhage is a rare and life-threatening condition that results from non-traumatic visceral artery rupture in the latter half of pregnancy and within the postpartum period [1-3]. CASE PRESENTATION: A 32 -year-old woman presented to emergency department, 14 weeks post-partum, with sharp left sided abdominal pain, nausea, and vomiting. Initial computed tomography (CT) was suggestive of non-specific colitis from transverse to descending colon of unclear cause. Six hours into admission she became haemodynamically unstable with abdominal peritonism resulting in emergency laparotomy. Intra-operative findings showed large volume haemoperitoneum with an active bleed from the middle colic artery. CLINICAL DISCUSSION: Symptoms and clinical presentation of Idiopathic spontaneous intraperitoneal haemorrhage is variable and ranges from vague abdominal pain to haemorrhagic shock. A latent period of several hours may be followed by a rapid progression of symptoms owing to rapidity of extravasation[3]. Pathogenesis has been suggested to arise from the increased physiologic demands during the intrapartum period, wherein repeated distension of vessels and increased tortuosity leads to a predisposition for rupture [4]. CONCLUSION: Diagnosis of Idiopathic spontaneous intraperitoneal haemorrhage is difficult but should be a differential in those who are post-partum presenting with abdominal pain. Patients should be assessed with CT angiography and treatment focused around aggressive resuscitation, surgical exploration, and ligation [3].

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