Spontaneous intra-abdominal bleeding as the first sign of liver cirrhosis: a case report

Spontaneous intra-abdominal bleeding in cirrhotic patients is commonly the result of variceal rupture, usually in the gastrointestinal tract. Ectopic varices account for only 2-5% of variceal bleeding in the gastrointestinal tract, yet they carry a fourfold higher risk of hemorrhage compared with esophageal varices and can be associated with mortality rates of up to 40%. We present the case of a 51-year-old male with no past medical history of liver cirrhosis, who was admitted with hypotension and syncope. Imaging and laboratory findings were consistent with liver cirrhosis with ascites and splenomegaly. Exploratory laparotomy revealed massive hemoperitoneum originating from ectopic variceal bleeding. Surgical intervention and supportive management led to an uneventful recovery. This rare case underlines the importance of high clinical suspicion and early surgical intervention in spontaneous hemoperitoneum in cirrhotic patients.