2013-01-09 17:20:30 UTC

<em>CGH</em> Image of the Month

Jan. 10, 2013

This month's Clinical Gastroenterology and Hepatology image examines a case of hemoperitoneum caused by spontaneous rupture of the umbilical vein in cirrhosis.

Hemoperitoneum Caused by Spontaneous Rupture of the Umbilical Vein in Cirrhosis

A 64-year-old man was brought to the emergency department after experiencing sudden mesogastric abdominal pain with subsequent syncope and spontaneous recovery. His medical history included insulin-dependent diabetes mellitus and portal hypertension from alcoholic liver cirrhosis with grade II esophageal varices and chronic low platelet count as a result of splenomegaly. He only had pedal edemas as previous decompensations of his liver disease, but ultrasonography had shown intra-abdominal collateral circulation, a repermeabilized umbilical vein, and an enlarged spleen. His current medications were insulin, metformin and propranolol. At hospital admission, the patient had hypotension (88/47 mm Hg) without tachycardia, and his abdomen was soft, nontender, and nondistended, with a prominent repermeabilized cutaneous umbilical vein, hepatosplenomegaly, and present bowel sounds. Thoracic examination was unremarkable, and the nasogastric tube aspiration was negative for blood. Laboratory data showed hemoglobin of 7.8 mg/dL and a platelet count of 89,000/mm3. Previously normal renal test results were acutely impaired (urea, 64 mg/dL; creatinine, 3.2 mg/dL). Computed tomography scan was performed after hemodynamic stabilization, and it showed a prominent repermeabilized umbilical vein with a contrast leak (arrow) and the presence of a large amount of intra-abdominal fluid with bloody characteristics (Figure A).

Read more in Clinical Gastroenterology and Hepatology.

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