Skip to main content
SpringerLink
Log in

Radiological diagnosis and management of idiopathic spontaneous intra-abdominal haemorrhage (abdominal apoplexy): a case series

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

Idiopathic spontaneous intraperitoneal haemorrhage (ISIH), historically known as abdominal apoplexy, is spontaneous haemorrhage due to rupture of an intra-abdominal visceral vessel in the absence of trauma or underlying pathology. It is an exceptionally rare condition, with mostly scattered case reports available. The aim of this study was to describe this rare condition, possible associated risk factors, and usefulness of multislice-CT (MS-CT) angiogram in its diagnosis prior to intervention.

Methods

A retrospective review of patients diagnosed with ISIH. Radiological records of haemoperitoneum from a single tertiary hospital in 2006–2013 were analysed, and the cases of ISIH were identified. Demographics (including pre-morbid hypertension status), abdominal aortic calcification as a measure of atherosclerotic changes, MS-CT angiogram +/− conventional digital subtraction angiograph images, surgical records and outcomes were reviewed.

Results

425 cases of haemoperitoneum were retrieved from hospital radiology database from 2006 to 2013, and 5 patients (1.1%) diagnosed with ISIH were identified (4 males, 1 female, mean age of 64 years). 4 out of 5 patients (80%) had a history of hypertension (mean 150/90 mmHg) and 3 patients had moderate abdominal aortic atherosclerosis. MS-CT angiogram was able to diagnose the bleeding source in 4 out of 5 patients, while the bleeding source remained occult in the last patient even with both MS-CT and traditional DSA angiography. Patients who underwent either embolization or surgery had no further re-bleeding in clinical follow up, ranging from 5 to 8 years.

Conclusions

Hypertension and abdominal aortic atherosclerosis appear to be associated risk factors for ISIH, and MS-CT angiogram has a high sensitivity in detecting the site of haemorrhage. An integrated angiographic and surgical approach is important in managing patients with ISIH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Cawyer JC, Stone CK (2011) Abdominal apoplexy: a case report and review. J Emerg Med 40(3):e49–e52

    Article  PubMed  Google Scholar 

  2. Matsumoto T, Yamagami T, Morishita H, et al. (2011) Transcatheter arterial embolization for spontaneous rupture of the omental artery. Cardiovasc Intervent Radiol 34:S142–S145

    Article  PubMed  Google Scholar 

  3. Suber WJ Jr, Cunningham PL, Bloch RS (1998) Massive spontaneous hemoperitoneum of unknown etiology: a case report. Am Surg 64:1177–1178

    PubMed  Google Scholar 

  4. Hamilton JD, Kumaravel M, Censullo ML, et al. (2008) Multidetector CT evaluation of active extravasaion in blunt abdominal and pelvic trauma patients. RadioGraphics 28(6):1603–1616

    Article  PubMed  Google Scholar 

  5. Lockhart ME, Robbin ML, McNamara MM, Allon M (2004) Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients. Nephrol Dial Transplant 19:2564–2569

    Article  PubMed  Google Scholar 

  6. Cauhoun DA, Jones D, Textor S, et al. (2008) Resistant hypertension: diagnosis, evaluation, and treatment. Hypertension 51:1403–1419

    Article  Google Scholar 

  7. Carmeci C, Munfakh N, Brooks JW (1998) Abdominal apoplexy. South Med J 91:273–274

    Article  CAS  PubMed  Google Scholar 

  8. Lafferty CR, Pearson B (1940) Intraperitoneal hemorrhage in essential hypertension. Am J Surg 48(2):460–462

    Article  Google Scholar 

  9. Jadav M, Ducheine Y, Brief D, et al. (2004) Abdominal apoplexy: a case study of the spontaneous rupture of the gastroepiploic artery. Curr Surg 61(4):370–372

    Article  PubMed  Google Scholar 

  10. Sun HP (2006) Preoperative diagnosis and successful surgical treatment of abdominal apoplexy—a case report. Tzu Chi Med J 18(6):452–455

    Google Scholar 

  11. Kleinsasser LJ (1970) Abdominal apoplexy. Report of two cases and review of the literature. Am J Surg 120:623–628

    Article  CAS  PubMed  Google Scholar 

  12. Carr SR, Dinsmore RC, Wilkinson NW (2001) Idiopathic spontaneous intraperitoneal hemorrhage: a clinical update on abdominal apoplexy in the year 2001. Am Surg 67:374–376

    CAS  PubMed  Google Scholar 

  13. Bandri F, Packirisamy K, Aryasighe L, Al Suwaidi M (2012) Abdominal apoplexy: a rare case of spontaneous rupture of the superior mesenteric artery in a hypertensive patient. Int J Surg Case Rep 3(12):614–617

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China

    Eric K. C. Law, Ryan K. L. Lee, Esther H. Y. Hung & Alex W. H. Ng

Authors
  1. Eric K. C. Law
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan K. L. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Esther H. Y. Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alex W. H. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric K. C. Law.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Law, E.K.C., Lee, R.K.L., Hung, E.H.Y. et al. Radiological diagnosis and management of idiopathic spontaneous intra-abdominal haemorrhage (abdominal apoplexy): a case series. Abdom Imaging 40, 343–351 (2015). https://doi.org/10.1007/s00261-014-0220-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0220-z

Keywords

Search

Navigation