Indications
- Ascites with Respiratory Compromise (see Ascites, [[Ascites]])
- Ascites with Suspicion of Spontaneous Bacterial Peritonitis (see Spontaneous Bacterial Peritonitis, [[Spontaneous Bacterial Peritonitis]])
Contraindications
- xxxx
Technique
- xxxx
Complications
Cardiovascular Complications
- Hypotension (see Hypotension, [[Hypotension]]): with large-volume paracentesis, resulting in hypovolemia
Gastrointenstinal Complications
- Hemoperitoneum (see Hemoperitoneum, [[Hemoperitoneum]]): see below
- Intestinal Perforation (see Intestinal Perforation, [[Intestinal Perforation]])
- Leak of Ascites from Puncture Site
Hemorrhagic/Vascular Complications
General Comments
- Prospective Study of Paracentesis-Related Complications (2009) [MEDLINE]: n = 171 patient (515 paracenteses) -> 8.8% diagnostic/91.2% therapeutic
- Major Complications: occurred in 1.6% of paracenteses (5 bleeding, 3 infection, 2 deaths)
- Risk Factors for Major Complications
- Alcoholic Cirrhosis
- Child-Pugh Stage C
- Performance of Therapeutic Paracentesis
- Thrombocytopenia (Platelets <50k)
- Technical Problems: occurred in 5.6% of paracenteses
- Most Frequent Complication: leak of ascites at the puncture site (5.0%)
- Systematic Review of Hemorrhagic Complications of Paracentesis (2014) [MEDLINE]
- Study: systematic review of 28 articles (90% of patients undergoing paracentesis had underlying cirrhosis)
- Main Findings
- Relative Frequency of Hemorrhagic Complications: abdominal wall hematoma (52%), hemoperitoneum (41%), and pseudoaneurysm (7%)
- Risk Factors for Hemorrhagic Complications
- Renal Failure (GFR <60, Cr >1.2): renal dysfunction was present in 70% of hemorrhagic complications
- Coagulopathy: present in 59% of hemorrhagic complications
- Higher MELD/Child-Pugh Classification
- Thrombocytopenia: present in 8% of hemorrhagic complications
s
Specific Hemorrhagic/Vascular Complications
- Hemoperitoneum (see Hemoperitoneum, [[Hemoperitoneum]])
- Pseudoaneurysm
- Abdominal Wall Hematoma
Neurologic Complications
- Hepatic Encephalopathy (see Hepatic Encephalopathy, [[Hepatic Encephalopathy]]): with large-volume paracentesis, resulting in hypovolemia
Other Complications
- Infection
- xxx
Management of Hemorrhagic Complications of Paracentesis
- Interventional Radiology Angioembolization
- There is a decreased 30-Day mortality rate with patients undergoing patients undergoing interventional radiology intervention, as compared to surgery [MEDLINE]
- Surgery: may be necessary in some cases
References
- Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol. 2009 Aug;7(8):906-9. doi: 10.1016/j.cgh.2009.05.004. Epub 2009 May 15 [MEDLINE]
- Hemorrhagic complications of paracentesis: a systematic review of the literature. Gastroenterol Res Pract. 2014;2014:985141. doi: 10.1155/2014/985141. Epub 2014 Dec 17 [MEDLINE]