Acute hemoperitoneum in horses: a review of 19 cases (1992-2003).
Authors: Pusterla N, Fecteau M E, Madigan J E, Wilson W D, Magdesian K G
Journal: Journal of veterinary internal medicine
Summary
# Acute Hemoperitoneum in Horses: Clinical Recognition and Management Bleeding into the peritoneal cavity represents a life-threatening emergency in equine practice, yet published guidance on recognition and treatment outcomes remains limited. This retrospective analysis examined 19 cases of acute hemoperitoneum over an 11-year period, identifying splenic haematoma with capsular rupture as the most common definitive cause (37% of cases), followed by idiopathic bleeding (42%) and reproductive tract haemorrhage (16%), with affected horses ranging from 4 to 32 years old. Clinicians should maintain high suspicion when encountering depression, tachycardia, prolonged capillary refill time, pale mucous membranes, and colic in combination; supportive laboratory findings typically include anaemia with neutrophilia, thrombocytopenia, hypoproteinemia, and azotemia, whilst abdominocentesis and transabdominal ultrasonography provided definitive diagnosis. Of the 16 horses receiving treatment involving aggressive fluid resuscitation, blood or plasma transfusion, and antifibrinolytic support, 14 survived (87.5% survival rate among treated cases), with median hospitalisation of 7 days, whereas three horses were euthanased at presentation and two deteriorated acutely despite treatment. For equine professionals, early recognition of the classic presentation, prompt diagnostic confirmation, and rapid initiation of multimodal medical support—including coagulation support with agents such as fresh frozen plasma and tranexamic acid—appear critical to improving survival outcomes in this previously high-mortality condition.
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Practical Takeaways
- •Recognize that acute hemoperitoneum presents with shock signs (depression, tachycardia, pale mucous membranes, prolonged CRT) combined with abdominal pain; splenic rupture and idiopathic bleeding are the most likely diagnoses
- •Abdominocentesis and transabdominal ultrasonography are essential diagnostic tools; be prepared for rapid deterioration requiring emergency euthanasia in some cases
- •Aggressive supportive care including IV fluids, blood/plasma transfusion, and coagulation support can achieve 74% survival; horses should be monitored closely in the first 24-48 hours post-presentation
Key Findings
- •Idiopathic hemoperitoneum (42%) and splenic hematoma with capsular tear (37%) were the most common causes among 19 horses with acute hemoperitoneum
- •Clinical presentation included depression, tachycardia, tachypnea, pale mucous membranes, prolonged capillary refill time, and colic
- •Clinicopathologic abnormalities commonly included anemia, neutrophilia, lymphopenia, thrombocytopenia, hypoproteinemia, and hypocalcemia
- •Overall survival rate was 74% (14 of 16 treated horses), with median hospitalization of 7.0 days