Fatally Idiopathic Spontaneous Hemoperitoneum in a Patient with Cervical Spine Injury: A Case Report and Review of the Literature
Chayanin Angthong MD*, Thanet Watthanaapisith MD**, Cholavech Chavasiri MD**
Affiliation : * Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat Hospital, Thammasat University, Pathum Thani, Thailand ** Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objectives: Idiopathic spontaneous hemoperitoneum has never been reported in patients with associated orthopedic injury.
The present report aimed to demonstrate a case of this life-threatening condition concomitant with cervical spine injury.
Case Report : A 50-year-old male was an illegal immigrant and transferred to the emergency department with the conditions
of the bilateral facet subluxation of C5-6 spine, including incomplete cord lesion (American-Spinal-Injury-Association:
grade-C) and without associated injury, caused by falling from a 3-meters-scaffold. He underwent anterior cervical discectomy,
fusion with iliac bone graft, and plating of C5-6 level at 20-hours after injury. His overall conditions recovered gradually with
the same neurological deficit as pre-operative status. On postoperative day 15, he developed acute hemodynamic instability
and cardiac arrest in an hour without preceding signs. Autopsy showed free intra-peritoneal blood 1,000 ml and fresh blood
in gastric lumen-small bowels 500 ml without definitive source of bleeding.
Discussion: The patient in this present report had no complaint of preceding abdominal symptoms in both pre-and-postoperative
periods. His visceral sensibility might be lost due to incomplete cord lesion. At this point, he might have an incompetency of
detection of intra-abdominal abnormality when it occurred. Hence, this patient had no classic symptoms of spontaneous
hemoperitoneum. This made the diagnosis of this condition quite difficult in the presented patient. This situation was very
uncommon and essentially unique.
Conclusion : The authors recommend “high index of suspicion” of this diagnosis as a cause of hemodynamic instability in
patients with neurological deficit, due to spine injury or any cause, which might prevent them to recognize antecedent
abdominal symptoms.
Keywords : Spontaneous hemoperitoneum, Idiopathic, Fatal, Cervical spine, Injury
