Idiopathic omentum hemorrhage as a cause of hemoperitoneum

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Abstract

Hemorrhage into the large omentum is a general term for a pathological condition in which an omental artery and/or vein ruptures with bleeding into the abdominal cavity and/or forming an omental hematoma. There is a high probability of its diagnosis only during surgery. This is an extremely rare condition, which is described only in clinical case reports. There are primary and secondary omental hemorrhage. Secondary hemorrhage occurs due to various reasons, primary (idiopathic) — in the absence of morphological changes that could lead to bleeding to the large omentum. The article is devoted to a rare case of idiopathic omentum bleeding complicated by hemoperitoneum, diagnosed intraoperatively. The article presents the results of a literary review of the last twenty years on English-language and Russian-language publications on omental hemorrhage, presented in the databases of PubMed and the Russian scientific electronic library (eLIBRARY.RU). According to the results of the analysis of the literature data, ultrasound can be used as a first-line imaging method to assess the presence of hemoperitoneum. But CT angiography is the method of choice in assessing acute intra-abdominal bleeding and determining the cause of bleeding due to its speed, availability and ability to diagnose alternative causes of abdominal pain, and it is also recommended to be performed in cases where ultrasound data do not allow to unambiguously establish the presence of bleeding or localize its source. Also, taking into account the age characteristics and gender of patients, the presence of bleeding into the omentum may be due to conditions such as cystic lymphangioma and interrupted ectopic pregnancy. Other causes may be vascular pathologies, tumors and anticoagulant therapy. When detecting signs of bleeding into the large omentum, in addition to determining the fact of hemoperitoneum and its volume, the most important tasks are to establish the causes of hemorrhage and differential diagnosis between idiopathic and secondary bleeding.

About the authors

Vladimir V. Ryazanov

Military Medical Academy; Saint Petersburg State Pediatric Medical University

Email: 79219501454@yandex.ru
ORCID iD: 0000-0002-0037-2854
SPIN-code: 2794-6820

M.D., D.Sc. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Gulnaz K. Sadykova

Military Medical Academy; Saint Petersburg State Pediatric Medical University

Email: kokonya1980@mail.ru
ORCID iD: 0000-0002-6791-518X
SPIN-code: 3115-7430

M.D., Ph.D. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Igor S. Zheleznyak

Military Medical Academy

Email: igzh@bk.ru
ORCID iD: 0000-0001-7383-512X
SPIN-code: 1450-5053

M.D., D.Sc. (Medicine)

Russian Federation, Saint Petersburg

Victor V. Ipatov

Military Medical Academy

Email: mogidin@mail.ru
ORCID iD: 0000-0002-9799-4616
SPIN-code: 2893-9880

M.D., Ph.D. (Medicine)

Saint Petersburg

Ilya S. Khodkevich

Saint Petersburg State Pediatric Medical University

Email: hishimiya@mail.ru
ORCID iD: 0000-0003-0359-5831
SPIN-code: 3508-2360

M.D., clinical resident

Russian Federation, Saint Petersburg

Roman A. Postanogov

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: r.a.postanogov@yandex.ru
ORCID iD: 0000-0002-0523-9411
SPIN-code: 8686-1597

Assistant of the Department of Modern Diagnostic Methods and Radiobeam Therapy named Professor S.A. Reinberg

Russian Federation, Saint Petersburg

Gennadiy G. Romanov

Military Medical Academy; Almazov National Medical Research Centre

Email: romanov_gennadiy@mail.ru
ORCID iD: 0000-0001-5987-8158
SPIN-code: 9298-4494

M.D., Ph.D. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Anastasiya Ya. Latysheva

Military Medical Academy

Email: vaska.petrova@yandex.ru
ORCID iD: 0000-0003-3677-8765
SPIN-code: 6793-1985

M.D., Ph.D. (Medicine)

Russian Federation, Saint Petersburg

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2. Rice. 1. CT images in the axial plane in the native (a, d, g, j) and arterial phase (b, e, h, k), corresponding to the secant lines on the image in the arterial phase in the frontal plane (c, e, i, m) at different levels. Hematoma in the upper left quadrant of the greater omentum in the form of imbibition of fatty tissue and fluid accumulation (white arrow). Extravasation from omental artery (white dotted arrow). Hemoperitoneum (circle)

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3. Rice. 2. Distribution of patients by gender and age (analysis literature)

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4. Rice. 3. Distribution of patients by methods performed X-ray studies: a - types of studies, b - methods in the complex of radiology diagnostics (literature analysis)

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5. Rice. 4. CT images in the axial plane in the native (a) and arterial phase (b) and the corresponding image in the arterial phase in the frontal plane at the level of extravasation (b, c; dotted arrow) from the omental artery (b, c; solid arrow)

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6. Rice. 5. MIP reconstruction of CT image in axial plane speed in the arterial phase at the level of extravasation (dotted arrow) from the omental artery (arrow)

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