A unique cause of hemoperitoneum: spontaneous rupture of a splenic hemangiopericytoma

Non-traumatic hemoperitoneum may occur spontaneously or may be iatrogenic. This uncommon and often unsuspected condition may be catastrophic if it is not promptly diagnosed and treated. The possible causes include hemorrhage from a highly vascular neoplasm, pathological splenic rupture, hemorrhage or rupture of an ovarian cyst, rupture of the gestational sac or other affected anatomic part in an ectopic pregnancy, bleeding from a vascular lesion, anticoagulation therapy, blood dyscrasias, surgery and invasive procedures. It is critical to identify the clinical picture and treat any active bleeding promptly [1]. We report the first case in the literature (to our knowledge) of spontaneous hemoperitoneum caused by a cystic splenic hemangiopericytoma.A 70-year-old man was admitted to our Urology Department with a 2-month history of left-sided abdominal pain. There was no significant past medical or family history. Previous ultrasonography had shown a 10-cm cystic lesion of the spleen and left hydronephrosis, and a further contrast-enhanced computer tomography evaluation confirmed a 12-cm cystic lesion located at the upper pole of the spleen suspected to be a hemorrhagic cyst and a suspected urothelial lesion of the pelvic ureter causing hydronephrosis.An electrocardiogram performed at admission documented an unknown atrial fibrillation with high ventricular response. The patient began pharmacological cardioversion with amiodarone, beta-blocking therapy in order to slow the heart rate, and anticoagulation therapy with enoxaparin 12,000 IU/day.Two days later, the patient developed two episodes of nausea, vomiting, confusion, and sweating associated with abdominal discomfort. The general examination was normal except for pallor, and his hemodynamic parameters were stable with a blood pressure of 110/80 mmHg, pulse of 70/min, and O2 saturation of 99% on room air. Blood tests revealed that his hemoglobin had dropped to 10.2 g/dl from the initial value of 14.5 g/dl. Urgent ul