Acute hemoperitoneum in horses: a review of 19 cases (1992-2003).

This research reviewed 19 cases of horses with acute hemoperitoneum, which is a condition where there is blood in the peritoneal cavity, often due to some internal bleeding or injury. The causes varied, with some remaining unknown, and the affected horses ranged from 4 to 32 years old. Various symptoms and clinical abnormalities were found, the most common being depression, tachycardia, and tachypnea. Hemoperitoneum was diagnosed through various methods and the majority of horses were treated and survived.

Summary of Cases

• The cases were comprised of 19 horses with acute hemoperitoneum, which occurred between 1992 and 2003.
• Horses of varying ages from 4 to 32 years old were affected, with a median age of 11.5 years.
• The causes of the hemoperitoneum varied, with the most common cause being idiopathic, which is when the cause remains unknown, affecting 8 horses. Other causes included splenic hematoma with capsular tear (7 horses), bleeding from the reproductive tract (3 horses), multicentric hemangiosarcoma (1 horse), and systemic amyloidosis (1 horse).

Clinical Findings

• Several symptoms were common among most horses, including depression, tachycardia, tachypnea, pale mucous membranes, prolonged capillary refill time, colic, and abdominal discomfort.
• Other less common symptoms included abdominal distention, excessive sweating, ataxia, and a broad ligament mass that was detectable through a rectal examination.
• Common clinicopathologic abnormalities detected included anemia, neutrophilia, lymphopenia, thrombocytopenia, hypoproteinemia, hypocalcemia, azotemia, increased creatinine kinase, and increased sorbitol dehydrogenase activity.

Diagnosis and Treatment

• Hemoperitoneum was diagnosed using methods such as abdominocentesis, transabdominal ultrasonography, and postmortem examinations.
• Out of the 19 horses, 16 were treated and 3 were euthanized at the owners’ request due to severe clinical signs.
• Treatments included intravenous fluids, plasma or blood transfusion, nonsteroidal drugs, antimicrobial drugs, and antifibrinolytic and procoagulant agents.
• Two horses experienced rapid clinical deterioration necessitating euthanasia, while the remaining 14 horses survived the abdominal bleeding, with a survival rate of 74%.
• Discharge occurred between 3 to 15 days after presentation, with a median of 7.0 days.

Postmortem Findings

• Six horses did not survive, and their postmortem examination revealed massive abdominal hemorrhages largely due to the various causes identified: splenic hematoma with capsular tear, multicentric hemangiosarcoma with liver rupture, systemic amyloidosis with splenic hematoma and capsular tear, and bilateral ruptured ovarian hematomas.
• In one case, the origin of the bleeding could not be determined even after postmortem examination.