Hemoperitoneum is a frequent complication of PD particularly among premenopausal women with an incidence of 6-57%1,2. It may be due to the peritoneal dialysis procedure or to factors unrelated to the procedure or to renal disease. The regular performance of dialysis exchanges allows early detection.
Etiology of Hemoperitoneum.
– Menstruation - ovulation
– Ovarian cyst - endometriosis
– Renal cell carcinoma
– Adenocarcinoma of colon
– Carcinomatosis of the liver or hepatoma
– Thrombocytopenic purpura- anticoagulation
• Polycystic diseases
– Splenic rupture or infarct, cholecystitis, pancreatitis, colonic perforation
• Sclerosing peritonitis
• Peritoneal calcification
• Retroperitoneal or iliopsoas hematoma
Evaluation and Management. Obtain white blood cell count in PD effluent and blood, amylase in PD fluid and culture at the first occurrence of hemoperitoneum. To determine the severity of bleeding obtain an effluent hematocrit and monitor changes in blood hemoglobin levels. Heavy recurrent bleeding associated with pain and fever demands urgent evaluation. An effluent hematocrit > 2% suggests severe bleeding. Further evaluation includes coagulation studies, abdominal imaging (CT scan, ultrasound, magnetic resonance, angiography). Rapid exchanges and the use of intraperitoneal heparin (500-1,000 U/l) as long as the dialysate has visible blood or fibrin have been recommended to prevent clotting. Oral contraceptives may prevent ovulation and control bleeding. Aspirin and anticoagulants should be stopped, if possible. If bleeding persists, surgical exploration may be required.
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Greenberg A, Bernardini J, Piraino BM, Johnston JR, Perlmutter JA. Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review. Am J Kidney Dis 19:252-256, 1992
Harnett JD, Gill D, Corbett L, Parfrey PS, Gault H. Recurrent hemoperiotneum in women receiving CAPD. Ann Int Med 107:341-343, 1987