Emoperitoneo
Che cos’è l’emoperitoneo?
Per emoperitoneo si intende la presenza di sangue libero nella cavità addominale.
Cause
Le cause sono molteplici e includono
- Traumi penetranti
- Rottura di aneurisma dell’aorta addominale, dell’utero o di neoplasie addominali
- Perforazione di ulcera gastrica o di visceri addominali
- Gravidanza ectopica
- Rottura del corpo luteo
- Coagulazione intravascolare disseminata (CID)
- Lesioni epatiche o spleniche.
Sintomi
Il segno clinico cardine è rappresentato dall’ anemia, che si instaura acutamente e impone un trattamento immediato. Se l’emorragia è grave si può manifestare un quadro di shock emorragico. Per shock emorragico si intende la condizione in cui il flusso ematico verso i tessuti periferici risulta inadeguata al mantenimento delle funzioni vitali.
Clinicamente emoperitoneo è associato a ipotensione e oliguria. Il dolore non è un sintomo costante, la sua insorgenza dipende dalla causa e dalla sede dell’emorragia. Se la lesione è localizzata al fegato o alla milza, il dolore è localizzato in sede ipocondriale e si può irradiare in aree diverse (per esempio in caso di rottura di milza, è tipica l’irradiazione alla spalla sinistra, detta segno di Kenr).
In caso di emoperitoneo, il sangue tende a raccogliersi nel cavo pelvico ed è apprezzabile tramite esplorazione rettale come una massa fluttuante e dolente.
Diagnosi
La diagnosi si avvale di:
- Ecografia e TC (Tomografia computerizzata) che sono in grado di individuare il versamento.
L’ecografia, eseguita da un operatore esperto, è in grado di individuare alterazioni ecostrutturali, (ematomi sottocapsulari, intraparenchimali, fratture, lacerazioni) degli organi parenchimatosi. In ogni caso, l’esame TC rappresenta il gold standard, permettendo di individuare lesioni traumatiche, valutarne la gravità e stabilire la gravità dell’ emoperitoneo. Una corretta valutazione tramite diagnostica strumentale permette di scegliere il trattamento più indicato.
Terapia
La terapia dell’emoperitoneo è chirurgica: evacuazione della raccolta di sangue e riparazione della lesione anche se ciò comporta il sacrificio totale o parziale di un viscere (milza, utero, anse intestinali ecc.).
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