Fatally idiopathic spontaneous hemoperitoneum in a patient with cervical spine injury: A case report and review of the literature

Abstract

Objectives: Idiopathic spontaneous hemo peritoneum 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 sub luxation 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 hemo dynamic 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 in competency of detection of intra-abdominal abnormality when it occurred. Hence, this patient had no classic symptoms of spontaneous hemo peritoneum. 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 hemo dynamic instability in patients with neurological deficit, due to spine injury or any cause, which might prevent them to recognize antecedent abdominal symptoms.