Idiopathic spontaneous hemoperitoneum in pregnancy: a case report with review of literature

ABSTRACT

Spontaneous hemoperitoneum in pregnancy is a rare cause of acute abdomen. Often in these cases the diagnosis made is obstetric emergencies like abruption, placentae or the commoner surgical emergencies in pregnancy. The causes of spontaneous hemoperitoneum include obstetric emergencies like ovarian cyst rupture, ectopic pregnancies which present in early pregnancy and uterine rupture and hepatic rupture in cases of HELLP syndrome which present in late pregnancy. Pregnancy may also predispose rarely to splenic rupture, rupture of visceral arteries like splenic and uterine and rupture of utero-ovarian veins. However in certain cases of spontaneous hemoperitoneum the site of bleeding may not be identified at surgical exploration. Even with recent advances in angiography there are cases where the site of bleeding is not identified. These cases of idiopathic spontaneous hemoperitoneum were historically termed as abdominal apoplexy. The first case of idiopathic spontaneous hemoperitoneum was reported in 1909. We report a case of idiopathic spontaneous hemoperitoneum at 32 weeks of pregnancy. Early operative intervention was done in the case which led to good maternal outcome. The fetal prognosis usually depends on the degree of prematurity. In our case the baby was premature and was discharged well after a 17-day NICU stay