Hemoperitoneum in patients receiving hemodialysis

Acute abdominal pain in chronic hemodialysis patients has well-known causes , including acute pancreatitis, mesenteric arterial insufficiency, or compl icated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom it ever the direct cause of the bleeding. Hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupt ure; therefore, it is more common in young women. In most cases, no specifi c treatment is required. Hemoperitoneum is rarely considered as the cause o f acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was n ot related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or scl erosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnorma lities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. Hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its inciden ce may be underestimated. Therefore, it should be considered whenever a chr onic hemodialysis patient presents with persistent acute abdominal pain. (C ), 2000 by the National Kidney Foundation, Inc.