Hemoperitoneum is the presence of blood

Blood

Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 in the peritoneal cavity

Peritoneal cavity

The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall...

. The blood accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Hemoperitoneum is generally classified as a surgical emergency; in most cases, urgent laparotomy

Laparotomy

A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...

 is needed to identify and control the source of the bleeding. In selected cases, careful observation may be permissible. The abdominal cavity is highly distensible and may easily hold greater than five liters of blood, or more than the entire circulating blood volume for an average-sized individual. Therefore, large-scale or rapid blood loss into the abdomen will reliably induce hemorrhagic shock and may, untreated, rapidly lead to death.

Causes

Causes of hemoperitoneum include:

• Penetrating trauma
• Blunt trauma, most commonly injuries to solid organs such as the liver
  Liver
  The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
  
   and spleen
  Spleen
  The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
  
  .
• Vascular accidents, such as rupture of an Abdominal aortic aneurysm
  Abdominal aortic aneurysm
  Abdominal aortic aneurysm is a localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent, and is the most common form of aortic aneurysm...
  
  , Iliac Aneurysm, or Splenic Aneurysm.
• Bleeding due to a ruptured ectopic pregnancy
  Ectopic pregnancy
  An ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
  
   or uterine rupture
  Uterine rupture
  Uterine rupture is a potentially catastrophic event during childbirth by which the integrity of the myometrial wall is breached. In an incomplete rupture the peritoneum is still intact. With a complete rupture the contents of the uterus may spill into the peritoneal cavity or the broad ligament...
  
  .
• Less commonly, bleeding due to a perforated gastric ulcer.
• Bleeding due to rupture of an intra-abdominal neoplasm, (e.g., Hepatoblastoma
  Hepatoblastoma
  Hepatoblastoma is an uncommon malignant liver neoplasm occurring in infants and children and composed of tissue resembling fetal or mature liver cells or bile ducts. Affecting 1 in 1.5 million. They are usually present with an abdominal mass...
  
  )
• Disseminated intravascular coagulation
  Disseminated intravascular coagulation
  Disseminated intravascular coagulation , also known as disseminated intravascular coagulopathy or consumptive coagulopathy, is a pathological activation of coagulation mechanisms that happens in response to a variety of diseases. DIC leads to the formation of small blood clots inside the blood...
  
  

Diagnosis

Hemoperitoneum can be reliably diagnosed with the following examinations:

• Focused assessment with sonography for trauma
  Focused assessment with sonography for trauma
  Focused Assessment with Sonography for Trauma is a rapid bedside ultrasound examination performed by surgeons and emergency physicians as a screening test for blood around the heart or abdominal organs after trauma.The four areas that are examined for free fluid are the perihepatic space...
  
   (FAST)
• Paracentesis
  Paracentesis
  Paracentesis is a medical procedure involving needle drainage of fluid from a body cavity, most commonly the peritoneal cavity in the abdomen.A related procedure is thoracocentesis, which is needle drainage of the chest cavity...
  
   or Diagnostic peritoneal lavage
  Diagnostic peritoneal lavage
  Diagnostic peritoneal lavage is a procedure where, after application of local anesthesia, a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel...
  
  
• Computed tomography
  Computed tomography
  X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
  
  
• Diagnostic laparoscopy
  Laparoscopy
  Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
  
   or exploratory laparotomy
  Exploratory laparotomy
  An exploratory laparotomy is the standard of care in various blunt and penetrating trauma situations in which there may be multiple life-threatening injuries, and in many diagnostic situations in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of...
  
  

Treatment

Classically, hemoperitoneum was an indication for emergency surgery to locate the source of bleeding. The method of control depends on the source of blood loss. Vascular bleeding, i.e. from a blood vessel, would be treated by clamping and ligation of the offending vessel, or repair of the vessel in the case of major arteries such as the aorta or mesenteric arteries. Bleeding from the spleen most often requires splenectomy, or removal of the spleen. Bleeding from the liver might be controlled by application of hemostatic sponges, thrombin, or more recently, argon beam cauterization.

With modern diagnostic aids such as Computed Tomography

Computed tomography

X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...

 (CT) scans, certain injuries such as low-grade lacerations of the spleen may be diagnosed early and observed, with surgical options deferred unless clinical deterioration obligates them. In rare occasions, rupture of an Abdominal Aortic Aneurysm may be repaired via an endovascular technique, though this is generally not performed in the setting of acute rupture.