Spontaneous intra-abdominal hemorrhage in hemophilia.

Intra-abdominal hemorrhage in patients with hemophilia is uncommon but represents a major cause of death in hemophiliacs. The manifestations are protean and may mimic other intra-abdominal processes. We present seven episodes of hemophilic intra-abdominal hemorrhage in which the initial diagnoses were incorrect in five of the seven cases. The mean time from seeking medical assistance to correct diagnoses was two days (range, zero to five days). Computed tomography proved useful, particularly when the diagnosis was uncertain or needed to be differentiated from other possibilities, such as aneurysm, tumor, or abscess. Delay in diagnosis and diagnostic and therapeutic misadventures can be minimized only by a knowledge of the nature of such hemorrhage.