Intra-Abdominal Bleeding

Clinical manifestations Intra-Abdominal Bleeding: Acute pain, which may be local or diffuse. Significant bleeding can lead to shock, abdominal distention and rigidity.

Diagnosis Intra-Abdominal Bleeding:
x History: Previous painful traumatic episode (vehicular accident, kick, fall, etc.) or neoplasia (bleeding metastasis)
x Ultrasound: Ultrasound follow-ups are advised because of the possibility of a delayed organ rupture.
x Laboratory findings: Hematocrit and hemoglobin tests are mandatory.
x Paracentesis: This is warranted in doubtful cases or in patients with copious intra-abdominal fluid.
x Exploratory laparotomy (diagnostic)

Sonographic findings Intra-Abdominal Bleeding:
– Essentially anechoic fluid surrounding the organs
– Older organized hematomas are usually nonhomogeneous and more echogenic.
– Blood may be localized or distributed throughout the abdominal cavity.
– Capsular discontinuity is seen with an organ rupture (kidney, spleen, liver,
etc.).

Accuracy of ultrasound diagnosis Intra-Abdominal Bleeding: Ultrasound can detect an intra-abdominal fluid volume as small as 10–15 mL. The nature of the fluid can be determined by guided needle aspiration. Rarely, tumors and metastases may rupture and bleed profusely.

Ultrasound Pictures Fig. 118a, b Intra-abdominal bleeding. a Echogenic clots (HAE; 2 days) in the right lower abdomen. b Arterial hemorrhage in progress, almost anechoic. Skiing injury