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HPB Surgery
Volume 2009, Article ID 240780, 5 pages
http://dx.doi.org/10.1155/2009/240780
Case Report

Hemoperitoneum in a Cirrhotic Patient Due to Rupture of Retroperitoneal Varix

1Department of General Surgery of Universitary Hospital and Clinics Hospital, University of São Paulo Medical School (FMUSP), 05403-000 São Paulo, SP, Brazil
2Section of Vascular Surgery, Clinics Hospital, University of São Paulo Medical School (FMUSP), Avienda Dr. Enéas de Carvalho Aguiar 255, 05403-000 São Paulo, SP, Brazil

Received 7 May 2008; Revised 7 October 2008; Accepted 3 February 2009

Academic Editor: Richard Charnley

Copyright © 2009 Igor Rafael Sincos et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The rupture of retroperitoneal varices is a rare and catastrophic complication of portal hypertension. We describe a case of this nature, the first in Brazilian medical literature, and also reviewing all previous 34 cases. We systematically analyzed all therapeutic approach and propose a management algorithm for diagnosis and treatment of this lethal condition. The majority of the patients presented with abdominal pain, distention and hypotension, and developed hemorrhagic shock. Rupture of retroperitoneal varices can be properly managed if an early diagnosis is made and surgery is performed promptly, which is the only effective treatment. Arteriography should be used when the suspicion is of rupture of hepatocellular carcinoma.