J Korean Surg Soc.  2010 Jun;78(6):369-375. 10.4174/jkss.2010.78.6.369.

Spontaneous Hemoperitoneum in Patients Taking Anticoagulants

• Baek JB
• Seong SH
• Won DY
• Bae KS
• Kim IY

• KMID: 2211967
• DOI: http://doi.org/10.4174/jkss.2010.78.6.369

Abstract

PURPOSE
Spontaneous hemoperitoneum is not a common disease but may cause a fatal outcome. Warfarin is a coumarin anticoagulant, used widely for therapeutic and prophylactic anticoagulation. Although, it is considered a life saving medicine, it is associated with significant adverse effects including intraabdominal bleeding. Literatures about spontaneous hemoperitoneum in patients taking anticoagulants have been reported, but until now there have not been a definite establishment in diagnostic criteria and treatment strategy.
METHODS
Among 209 patients who were diagnosed hemoperitoneum from Jan 2005 through May 2009, we identified 9 patients with spontaneous hemoperitoneum without any trauma history or solid organ abnormalities. All 9 patients were taking warfarin for various durations. Initially, we evaluated vital signs, laboratory, CT findings, and clinical course, retrospectively. In addition, we analyzed risk factors potentiating the pharmacologic effect of anticoagulants.
RESULTS
One of the most prominent features in this study is that all patients showed prolonged international normalized ratio (6.36~15.11). One patient received an exploratory laparotomy for hemoperitoneum secondary to warfarin, presenting as a localized peritonitis in the right lower quadrant of the abdomen. Mean hospital stay was 15.2 days. Five patients were transfused with packed red blood cells (500~1,000 ml) and fresh frozen plasma (300~900 ml). All patients were discharged without any mortality.
CONCLUSION
It is important to identify and confirm the factors that can potentiate the pharmacologic effect of anticoagulants, when acute abdomen is suspected in patients taking anticoagulants. If the patients are hemodynamically stable, they can be treated without surgical intervention.

Keyword

Hemoperitoneum; Anticoagulation

MeSH Terms

Abdomen
Abdomen, Acute
Anticoagulants
Coumarins
Erythrocytes
Fatal Outcome
Hemoperitoneum
Hemorrhage
Humans
International Normalized Ratio
Laparotomy
Length of Stay
Peritonitis
Plasma
Retrospective Studies
Risk Factors
Vital Signs
Warfarin
Anticoagulants
Coumarins
Warfarin

Figure

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  Fig. 1 CT scan shows intramural hemorrhage (A) and hemorrhage into pelvic cavity (B) in case 8.

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  Fig. 2 CT scan show resolved intramural hemorrhage (A) and nearly absorbed fluid collection in pelvic cavity (B) in case 8.

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