Abstract:
Background: Spontaneous hemoperitoneum (SH) is a rare and life-threatening surgical emergency typically associated with ruptured hepatic or splenic neoplasms, vascular aneurysms, or gynecologic complications. While Human Immunodeficiency Virus (HIV) is known to cause hematologic abnormalities, massive intraperitoneal hemorrhage as the initial and sole clinical manifestation of undiagnosed HIV is an exceptionally rare presentation.
Case Presentation: We report the case of a 23-year-old previously healthy Amharic male presenting with acute abdominal pain, distention, and signs of hypovolemic shock (Blood Pressure 90/60 mmHg). He denied a history of trauma, surgery, or anticoagulant use. Physical examination revealed diffuse abdominal tenderness and shifting dullness. Laboratory investigations demonstrated severe anemia (Hemoglobin 7.6 g/dL), mild thrombocytopenia (123,000/μL), and a significantly prolonged activated partial thromboplastin time (aPTT) of 60.2 seconds. During the workup for the etiology of coagulopathy, the patient was newly diagnosed with HIV infection with CD4 count (<200). Abdominal ultrasound and Computed Tomography (CT) confirmed massive hemoperitoneum without evidence of solid organ injury or active contrast extravasation. The patient was successfully managed conservatively with fluid resuscitation and blood transfusion.
Conclusion: This case illustrates spontaneous hemoperitoneum as an initial presentation in a newly HIV/AIDs patients. Clinicians should include HIV screening in the differential diagnosis for young patients presenting with "idiopathic" atraumatic intra-abdominal hemorrhage, particularly when accompanied by unexplained isolated prolongation of aPTT.
Biography:
Dr. Kalaab Sharew is a clinical epidemiologist and physician with a strong focus on Internal Medicine. He earned his Doctor of Medicine from St. Paul's Hospital Millennium Medical College and his Master of Public Health in Epidemiology from Injibara University, where he has also dedicated time as a lecturer and clinical skills facilitator. Currently advancing his specialized clinical training as an Internal Medicine resident, Dr. Sharew’s research integrates bedside practice with public health strategy. He actively collaborates with regional health bureaus to enhance chronic disease triage, specifically focusing on developing practical prediction models, and has published on a wide array of critical public health topics.
