Abdomen: hemoperitoneum

Intra-abdominal hemorrhage

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  • Hemoperitoneum, or abdominal hemorrhage, is defined as blood accumulation within the peritoneal cavity. 
  • It is an uncommon occurrence, and can be difficult to diagnose as the clinical signs are often non-specific and may mimic other diseases.  
  • Diagnostic and therapeutic decisions must be made rapidly, however, to prevent fatal ex-sanguination. 
  • Cause : multifactoral.
  • Signs : colic or abdominal discomfort, pale mucous membranes, tachypnea, tachycardia, depression.
  • Diagnosis : rectal examination, nasogastric intubation, peritoneal tap, blood biochemistry and hematology, platelet count, clotting times, ultrasonography, exploratory laparotomy.
  • Treatment : fluid therapy, blood transfusion, NSAIDs, antibiotics, corticosteroids, exploratory laparotomy and surgical repair.
  • Prognosis : good to poor depending on severity of blood loss and underlying cause.


Differential diagnosis


Clinical signs

  • Non-specific signs such as dullness, anorexia and depression.
  • Clinical signs may relate to either the discomfort of hemoabdomen or hypotensive shock produced by excessive blood loss, including:
    • Colic or mild abdominal discomfort  [Abdomen: pain - adult]  .
    • Abdominal distension.
    • Lack of normal borborygmi.
    • Pale mucous membranes.
    • Increased respiratory and heart rate.
    • Sweating.
    • Increased anxiety or depression. 
    • If hemoabdomen is secondary to a generalized coagulopathy, epistaxis and mucous membrane petechia or ecchymosis  [Blood: petechiae / ecchymoses / bruising]  may also be present.



  • Short-term survival rates vary between studies: rates of 39%, 51% and 74% have been reported:
    • Most of the animals that either died or were euthanized had short clinical courses due to the severity of the blood loss, ie within 24 h of presentation. 
    • Heart rate >60 bpm and respiratory rate >30 breaths/min have a poorer prognosis. 
    • Horses with hemoabdomen due to DIC  [Disseminated intravascular coagulation]  , neoplasia    , splenic injury, mesenteric injury or uterine artery rupture    , had a poorer prognosis for life when compared to horses with either trauma or idiopathic hemoperitoneum.

Expected response to treatment

  • It would be expected for horse to stabilize cardiovascularly, resulting in a PCV and total protein that stops falling and begins to increase, and a decrease of heart rate and respiratory rate to normal levels.
  • Abdominal discomfort should resolve.

Reasons for treatment failure

  • Blood loss is too rapid to replace, resulting in fatal ex-sanguination.
  • Administration of crystalloids only, with failure to provide whole blood where required, and therefore worsening of the anemia.
  • Neoplasia (non-resectable or disseminated).
  • Subsequent development of septic peritonitis.
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