Kosin Med J.  2020 Jun;35(1):52-57. 10.7180/kmj.2020.35.1.52.

A Case of unexpected Fatal Hemoperitoneum in Non-severe Acute Pancreatitis

Affiliations
  • 1Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Hankook General Hospital, Cheongju, Korea

Abstract

Acute pancreatitis (AP) severity is determined by associated organ failure (OF). However, enzymatic erosion of peripancreatic vessels can lead to life-threatening hemoperitoneum in clinically non-severe AP without OF. We herein report a case of unexpected hemoperitoneum which developed in a patient with clinically resolving AP without OF. A 36-year-old woman with alcohol use disorder presented with resolving epigastric pain and sustained abdominal distension of 2 weeks’ duration. Ranson’s score on admission was 1 and Computed tomography (CT) revealed non-necrotic AP with peripancreatic fluid collection. She showed sudden hypotension with an abrupt decrease in serum hemoglobin within 24 hours after admission. She was suspected to have an acute hemoperitoneum associated with venous bleeding from AP based on repeated CT. Venous bleeding from the splenic branch was ligated during surgery. The possibility of bleeding at the pancreatic bed should be considered even if the pancreatitis is not severe.

Keyword

Alcoholic; Hemoperitoneum; Pancreatitis; Surgery

Figure

  • Fig. 1 Liver dynamic computed tomography (CT) scan of patient taken within 4 hours of admission. (A) There are multiple cystic lesions in pancreas presumed to be small pseudocysts in portal phase. (B) Peripancreatic fluid collection is notable at the pancreas head in portal phase (arrow). (C) There is active leakage of contrast media from the mesenteric vessel at duodenojejunal junction in delayed phase (arrow).

  • Fig. 2 Abdominal pelvis CT scan of patient taken after 29 hours of first CT scan immediately after clinical hypotensive event. (A) There is evidence of hemoperitoneum in left upper quadrant in non-contrast enhanced image (arrow) without active leakage of contrast media in arterial phase. (B) Newly developed hemoperitoneum is notable in pelvic cavity in non-contrast enhanced image (arrow).


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