Hemoperitoneum
Basic Information 
Clinical Presentation
Physical Exam Findings
• Clinical signs related to hypovolemia and hemorrhagic shock, including:
• Moderate to severe gross abdominal distension is often noted, especially in the later stages.
• A mesenteric or broad ligament hematoma may be palpated on rectal examination, although the rectal examination is often within normal limits in horses with hemoperitoneum.
Etiology and Pathophysiology
• Rupture of an intraabdominal vessel or organ may occur with any of the following conditions:
• Idiopathic hemoperitoneum also occurs with some frequency in adult horses with no historical risk factors or identifiable cause or source of hemorrhage.
• Rarely, hemorrhage may be confined to the mesentery; intestinal or uterine wall; or within the hepatic, splenic, or renal capsule. In these cases, horses may present with clinical and clinicopathologic findings consistent with acute intraabdominal hemorrhage, but the ultrasonographic findings and peritoneal fluid analysis may not demonstrate frank hemorrhage in the peritoneal cavity.
Diagnosis 
Differential Diagnosis
Strangulating intestinal obstruction (in horses with signs of severe abdominal pain)
Initial Database
• Packed cell volume (PCV) and total solids (TS)
May be normal in acute stages. A disproportionate decrease in TS concentration is often noted before the PCV decreases significantly.
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