- 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.
- 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.
- 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.