Key Points
With the patient in the supine position:
- Hemoperitoneum starts with bleeding from site of injury then blood flows along anatomical pathways to reach most dependent areas
- Most dependent portion of the abdomen is the hepatorenal recess/fossa (Morison's pouch)
- Most dependent portion of the pelvis is the pelvic cul-de-sac (pouch of Douglas)
- Hepatic and splenic bleeding will typically travel along paracolic gutters to the cul-de-sac (rectouterine space in women and rectovesical space in men) if patient not supine.
- Significant abdominal bleeding may occur without detectable haemoperitoneum as it can be contained within the organ capsule
