Massive Hemoperitoneum due to a Ruptured Umbilical Vein in a Cirrhotic Patient

The patient is a 46-year-old woman diagnosed 6 months earlier with alcoholic cirrhosis. She came to the ER with abdominal pain in the umbilical region and flanks. Blood workup detected anemia (hemoglobin: 7.8). The gastroenterology department ruled out digestive tract bleeding. In the emergency room, she presented hypotension and cardiorespiratory arrest. CT angiography revealed a cirrhotic liver, and massive hemoperitoneum with contrast extravasation in the repermeabilized umbilical vein (Figs. 1 and 2). Laparotomy showed hemoperitoneum, cirrhosis with repermeabilization of the umbilical vein, with no other signs of portal hypertension. The umbilical vein was ligated and the hemoperitoneum evacuated. The patient developed irreversible multiple organ failure and died on the seventh day post-op.

Fig. 1

Fig. 2