Abdominal Apoplexy: Description, Causes, and Risk Factors:
Mesenteric hemorrhage, thrombosis, or embolus involving the mesenteric or abdominal blood vessels. Abdominal apoplexy is a rare and often fatal.
Traditionally abdominal apoplexy refers to the spontaneous rupture of an abdominal splanchnic vessel after excluding hemorrhage from gross aneurysms, gynecological lesions, visceral malignancies, trauma and any inflammatory or obvious pathological states. The following popper user interface control may not be accessible. The most common sources of non-traumatic visceral artery rupture are from aneurysms or pseudoaneurysms, with approximately 30% of cases showing no identifiable source.
Although the condition is extremely rare and the real incidence is unknown, abdominal apoplexy should be considered a differential diagnosis in a patient with a history of hypertension presenting with signs of acute abdomen and hemodynamic instability.
Clinical presentation of abdominal apoplexy is variable, with no identifiable pathognomic sign or symptom. The universal symptom, however, is the sudden onset of abdominal pain, which may subside as the bleeding ceases or is minimal, but often rapidly progresses to profound shock with sudden, excruciating pain accompanied by a drop in hemoglobin and hematocrit.
The recommended radiological approach if spontaneous abdominal hemorrhage is suspected is a Monophasic CT Angio with arterial phase only (without oral contrast media); it is an effective method for detecting hemoperitoneum and active arterial extravasation.In an unstable patient, a Focused Assessment with Sonography for Trauma (FAST) would be the alternative. Diagnostic Peritoneal Lavage (DPL) is the most sensitive (and most invasive) test to identify spontaneous intra-abdominal hemorrhage; however, a negative result does not eliminate the diagnosis of abdominal apoplexy.
If active extravasation of blood or arterial bleeding is detected on CT, percutaneous transcatheter embolization therapy can be considered as an alternative option to surgery in the stable patient and if the patient is not a surgical candidate. It may also be used as an adjunct to surgery to overcome a life-threatening bleeding prior to definitive surgical treatment. Hemodynamically unstable patients require an immediate exploratory laparotomy.
NOTE: The above information is an educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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