An unusual case of traumatic hemoperitoneum

The authors describe the case-history of an uncommon traumatic haemoperitoneum which developed during sexual intercourse in a 49-year-old woman. She was admitted to the department of surgery of the Kromĕriz Hospital on account of pain in the epigastrium. Previously the patient was free from complaints and collapsed on the way to the toilet. On admission she lacked sign of cardiopulmonary failure, on examination of the abdomen only deep painfulness on palpation in the epigastrium was found, on laboratory examination leukocytosis, the sonographic finding was negative. Two hours after admission signs of haemorrhagic shock developed, on abdomen symptoms of diffuse peritoneal irritation and on repeated sonographic examination accumulation of fluid in the abdominal cavity. The patient was subjected to an urgent operation with finding of rupture of a lienal aneurysm. Resection of the aneurysm and splenectomy were performed. During the subsequent course the patient was twice revised on account of a left-sided subphrenic abscess, now (six month after the first operation) she is free from complaints. The authors analyze incidence, etiology, clinical picture and treatment of aneurysm of the lienal artery. As to the clinical picture they emphasize the typical picture of two-stage rupture.