Hemorrhagic Complications of Paracentesis: A Systematic Review of the Literature

Abstract

Introduction. Large volume paracentesis is considered a safe procedure carrying minimal risk of complications and rarely causing morbidity or mortality. The most common complications of the procedure are ascitic fluid leakage, hemorrhage, infection, and perforation. The purpose of this study was to evaluate all hemorrhagic complications and their outcomes and to identify any common variables. Methods. A literature search for all reported hemorrhagic complications following paracentesis was conducted. A total of 61 patients were identified. Data of interest were extracted and analyzed. The primary outcome of the study was 30-day mortality, with secondary endpoints being achievement of hemostasis after intervention and mortality based on type of intervention. Results. 90% of the patients undergoing paracentesis had underlying cirrhosis. Three types of hemorrhagic complications were identified: abdominal wall hematomas (52%), hemoperitoneum (41%), and pseudoaneurysm (7%). Forty percent of the patients underwent either a surgical (35%) or an IR guided intervention (65%). Patients undergoing a surgical intervention had a significantly higher rate of mortality at day 30 compared to those undergoing IR intervention. Conclusion. Abdominal wall hematomas and hemoperitoneum are the most common hemorrhagic complications of paracentesis. Transcatheter coiling and embolization appear to be superior to both open and laparoscopic surgery in treatment of these complications.

The Evolving Role of Ultrasound in Emergency Medicine

“…The practitioner should avoid the upper quadrants, given the proximity of the liver and spleen to the abdominal wall. They should also avoid 11 and 2 o'clock angles of the abdomen to prevent inadvertently puncturing the inferior epigastric arteries, a known cause of hemorrhagic complications [66]. A pocket of 3-4 cm between the abdominal wall and the free-floating loops of bowel is adequate and is usually found in the lateral-most aspect of the abdomen [11].…”

Response

“…These recommendations can be found in Section 8.6 of the respective labels. 3,4 1306 Correspondence [ 1 5 5 # 6 C H E S T J U N E 2 0 1 9 ]…”

Cirrhosis-related musculoskeletal disease: radiological review

“…Abdominal wall bleeding is a rare but lethal complication of LVP. [49][50][51] It has often been anecdotally attributed to underlying coagulopathy and thrombocytopenia in patients with cirrhosis. However, literature is divided over this and there are reports both supporting and refuting this hypothesis.…”

“…However, literature is divided over this and there are reports both supporting and refuting this hypothesis. [48][49][50][51] Although the exact incidence of haemorrhagic complication in patients with cirrhosis and portal hypertension is unknown, studies have reported incidence rates of between 0.8 and 3.0%. 51 Signs and symptoms of haemorrhage can manifest from minutes to days after the procedure.…”