Ruptured mesenteric varix in cirrhosis--unusual cause for hemoperitoneum.

New England Journal of Medicine (Impact Factor: 54.42). 02/1968; 278(2):97-8. DOI: 10.1056/NEJM196801112780208
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    ABSTRACT: A 41-year-old woman died within a few hours one morning due to massive rectal hemorrhage. At autopsy, complete liver cirrhosis, signs of portal hypertension, liquid blood in the entire colon, and high-grade anemia were detected. The source of bleeding was a ruptured submucosal varix in the sigmoid colon, which was almost invisible even microscopically and had been caused by portal hypertension. In the vicinity, and somewhat further away from the rupture site, numerous, greatly dilated veins with wall sclerosis and intimal thickening, as well as paravascular iron deposits, were found as indications that severe hemorrhages had already occurred earlier. To detect the source of bleeding, meticulous inspection and dissection with hematoxylin and eosin, elastica van Gieson, and iron staining, were necessary.
    Zeitschrift fur Rechtsmedizin 03/1985; 94(1):61-69. DOI:10.1007/BF00200524
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    ABSTRACT: : Hepatosplenic schistosomiasis is due to chronic parasitic trematode infections with various Schistosoma sp. The Schistosoma life cycle requires contamination of surface water by infected human or animal excreta, specific freshwater snail intermediate hosts and human skin contact with water. The disease is prevalent in many developing tropical areas, particularly in sub-Saharan Africa as well as in Southeast Asia. Deposition of Schistosoma eggs in the hepatic portal system leads to periportal fibrosis, cirrhosis and portal hypertension but little hepatocellular damage. Portal hypertension of any etiology may cause gastrointestinal varices. Rarely, ectopic varices may rupture into the peritoneal cavity and result in a hemoperitoneum. The authors describe a case of a Filipino immigrant who presented with a hemoperitoneum associated with previously unrecognized hepatosplenic schistosomiasis due to Schistosoma japonicum.
    The American Journal of the Medical Sciences 04/2013; 346(4). DOI:10.1097/MAJ.0b013e31828f4bee · 1.52 Impact Factor
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    ABSTRACT: Varices are caused by increased hemodynamic stress on venous channels due to portal hypertension complicating cirrhosis. Although esophageal varices are the most common site of variceal rupture in cirrhosis, mesenteric variceal rupture causing hemoperitoneum is a rare but fatal complication. There are three similar previously reported cases in the literature. We report a fatal case of hemoperitoneum in a woman caused by spontaneous rupture of mesenteric varices as a result of cirrhosis due to chronic alcoholism. The original site of hemorrhage may remain obscure if the lesion is subtle and overlooked. Therefore a diligent search for mesenteric varices is indicated in all cases with unexplained hemoperitoneum.
    06/2011; 1(2):77–79. DOI:10.1016/j.ejfs.2011.05.001