Assael Dylan J, Sauk Steven C
Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri.
Semin Intervent Radiol. 2023 Jul 20;40(3):274-278. doi: 10.1055/s-0043-1769906. eCollection 2023 Jun.
Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis. Angiography was performed, without revealing an arterial source of bleeding. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed via a recanalized middle hepatic vein, reducing the patient's portosystemic gradient from 15 to 6 mm Hg. This patient developed no further signs or symptoms of bleeding and remained hemodynamically stable until discharge. Follow-up imaging confirmed patency of her shunt and resolution of her ascites, without the need for future paracentesis. This case highlights that in the absence of arterial extravasation, the possibility of ectopic variceal hemorrhage should be considered, which can be successfully treated with portosystemic shunt creation.
腹腔穿刺术被认为是安全的操作；然而，对于门静脉高压患者，腹内压的快速变化可促使异位静脉曲张出血。关于这种临床情况下的恰当处理，相关文献很少。在此，我们描述一名继发于布加综合征的门静脉高压患者，在腹腔穿刺术后出现大量腹腔积血。进行了血管造影，未发现动脉出血源。随后，通过再通的肝中静脉进行经颈静脉肝内门体分流术，将患者的门体压力梯度从15毫米汞柱降至6毫米汞柱。该患者未再出现出血的体征或症状，直至出院一直保持血流动力学稳定。随访影像学检查证实分流管通畅且腹水消退，无需再次进行腹腔穿刺术。该病例强调，在没有动脉外渗的情况下，应考虑异位静脉曲张出血的可能性，通过建立门体分流术可成功治疗。
