Refers to the presence of blood in the peritoneal cavity.

Usually a surgical emergency.

Laparotomy usually is required to identify and control the source of the bleeding, but observation may be appropriate in certain circumstances.

Large-scale or rapid blood loss can induce hemorrhagic shock and lead to death.

Causes include: penetrating trauma, blunt trauma with liver or spleen injury, rupture of an abdominal, iliac or splenic aneurysm, a ruptured ectopic pregnancy, uterine rupture, ruptured corpus luteum, perforated viscus, rupture of intraabdominal malignancy, DIC, and complication of anticoagulants,

Diagnostic evaluation includes: abdominal US, diagnostic paracentesis or diagnostic peritoneal lavage, abdominal/pelvic CT exam and diagnostic laparoscopy or exploratory laparotomy

Initial management consists of fluid resuscitation if the patient is in hemorrhagic shock.

Surgery is to locate the source and to control the bleeding.

Specific injuries such as low-grade lacerations of the spleen may be diagnosed early by CT exam and observed, unless clinical deterioration occurs.

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