Paracentesis

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

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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]