Vaginal bleeding from massive hemoperitoneum. A case report

BACKGROUND: A gynecology service is often asked to consult and evaluate in-house patients with vaginal bleeding. CASE: A 31-year-old, Asian woman with a history of end-stage renal disease and hemodialysis was admitted to the hospital with a falling hematocrit. She subsequently began to have heavy vaginal bleeding. Computed tomography suggested a peritoneal-cervical fistula. Subsequent exploratory laparotomy documented that the bleeding was caused by retrograde flow of a hemoperitoneum. CONCLUSION: This appears to be the first reported case of retrograde flow from a hemoperitoneum causing vaginal bleeding. Although unusual, this case expands the differential diagnosis when evaluating vaginal bleeding.