When fluid blood escapes into the normal pelvic cavity it can not be palpated, because it forms no distinct resisting mass. The hemorrhage is free and unlimited.
If the patient survive, the blood soon coagulates; the clots gravitate to the lowest part of the pelvis; the dependent intestinal loops are floated up above the clot, and all other pelvic viscera are displaced in the direction of least resistance. The unabsorbed blood serum, together with the lymph poured out by the surrounding peritoneal surfaces, covers the blood clot, fills the interstices between the intestinal coils, fills the gaps between the displaced viscera and, becoming organized, constitutes a false membrane of varying thickness, which more or less effectually shuts off the blood mass from the rest of the peritoneal cavity. This blood mass together with whatever débris may be enclosed within, can be readily palpated both externally and internally. The longer the
ROSENWASSER M. THE TREATMENT OF CIRCUMSCRIBED PELVIC HEMORRHAGE.. JAMA. 1897;XXIX(22):1093–1097. doi:10.1001/jama.1897.02440480009001b