Fatal Spontaneous Hemoperitoneum in a Patient with Cervical Spine Injury: A Case Report

摘要

Introduction: Severe spontaneous hemoperitoneum has been rarely reported in the literature. The morbidity and mortality rates were quite high from the previous report.rnObjectives: To our knowledge, this problem in orthopaedic patient has never been reported and identified in previous literatures. We reported this case study for awareness of this problem in a patient with cervical spine injury. Materials and Methods: We present a lethal massive spontaneous hemoperitoneum in a 50-year-old male with 2-weeks previously, cervical spinal injury caused by falling from 3-meters scaffolding at the construction area and had bilateral facet subluxation at the C5-6 level with incomplete cord lesion (American spinal injury association: ASIA C grade) without another associated injuries. He underwent an operation as the anterior cervical discectomy and fusion with iliac bone graft and plating at the C5-6 level after 20 hours of the injury. On the fourteenth day after an injury, the patient developed acute hemodynamic unstable and cardiac arrest in an hour. The patient had no previously abdominal complaint. Results: The postmortem examination revealed intraperitoneal fresh blood 1,000 milliliters and fresh blood in stomach and bowels 500 milliliters without identification of definitive source of bleeding. There was no determining finding of other abnormalities.rnConclusion and Significance: We emphasized the importance of a high index of suspicion of this diagnosis in the patient who had previous trauma, particularly in cervical spinal injury with neurological deficit that might prevent the patient to recognize preceding abdominal symptoms.