Berry Andrew C
Gastroenterology, Larkin Community Hospital, South Miami, USA.
Cureus. 2020 Jun 25;12(6):e8827. doi: 10.7759/cureus.8827.
Large-volume paracentesis carries roughly a 1% risk of overall complications. Hemorrhagic complications are classified as abdominal wall hematomas, pseudoaneurysms, and hemoperitoneum. Severe hemorrhage is rare (<0.2%), with death following this complication seen in <0.02% of cases. We present a fatal case of an ultrasound-guided paracentesis leading to subsequent hemoperitoneum from an aberrant intercostal artery, causing hemorrhagic shock and death. A 47-year-old black male with decompensated alcoholic cirrhosis, model for end-stage liver disease (MELD) score of 22, and Child-Pugh class C presented with a distended abdomen, international normalized ratio (INR) 1.9, and hemoglobin 9.6 g/dL. An ultrasound-guided therapeutic paracentesis was performed in the right lower quadrant with 50 mL intravenous albumin given after 4 L of uncomplicated ascitic fluid removal. The patient became hypotensive, tachycardic, and placed on pressor support medication within 12 hours after the procedure. After a complex hospital course, the patient passed away on hospital day 10 after multisystem organ failure. The patient was found to have an aberrant intercostal artery bleed secondary to the paracentesis procedure causing an abdominal hemoperitoneum.
大量腹腔穿刺术总体并发症风险约为1%。出血性并发症分为腹壁血肿、假性动脉瘤和腹腔积血。严重出血罕见（<0.2%），该并发症导致的死亡见于<0.02%的病例。我们报告一例超声引导下腹腔穿刺术导致致命性腹腔积血的病例，出血源自一支异常肋间动脉，引起失血性休克并导致死亡。一名47岁黑人男性，患有失代偿期酒精性肝硬化，终末期肝病模型（MELD）评分22分，Child-Pugh C级，表现为腹部膨隆，国际标准化比值（INR）为1.9，血红蛋白9.6 g/dL。在右下象限进行了超声引导下的治疗性腹腔穿刺术，在引出4 L无并发症的腹水后给予50 mL静脉白蛋白。术后12小时内，患者出现低血压、心动过速，并开始使用升压支持药物。经过复杂的住院过程，患者在住院第10天因多系统器官衰竭去世。尸检发现患者因腹腔穿刺术继发异常肋间动脉出血，导致腹腔积血。
