title: Transcatheter coil embolization of the inferior epigastric artery in a huge abdominal wall hematoma caused by paracentesis in a patient with liver cirrhosis.
abstract: Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.
authors.affiliation: Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University School of Medicine, Jeonju, Korea.
authors.forename: Yun Ji
authors.initials: YJ
authors.lastname: Park
authors.forename: Sang Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Seong Hun
authors.initials: SH
authors.lastname: Kim
authors.forename: In Hee
authors.initials: IH
authors.lastname: Kim
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Seung Ok
authors.initials: SO
authors.lastname: Lee
mesh_terms: D034861:Abdominal Wall; D000792:Angiography; D001201:Ascites / Q000601:surgery; D004621:Embolization, Therapeutic; D019074:Epigastric Arteries / Q000293:injuries*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications
references.citation: Transfusion. 1991 Feb;31(2):164-71
references.pmid: 1996485
references.citation: N Engl J Med. 2006 Nov 9;355(19):e21
references.pmid: 17093242
references.citation: Arch Intern Med. 1986 Nov;146(11):2259-61
references.pmid: 2946271
references.citation: Arch Surg. 1996 Jan;131(1):102-3
references.pmid: 8546568
references.citation: Clin Gastroenterol Hepatol. 2005 Dec;3(12):1187-91
references.pmid: 16361042
references.citation: Br J Radiol. 2008 Mar;81(963):e64-7
references.pmid: 18270285
references.citation: J Gastroenterol Hepatol. 2009 Sep;24(9):1494-503
references.pmid: 19743995
references.citation: Gut. 2006 Oct;55 Suppl 6:vi1-12
references.pmid: 16966752
references.citation: Liver Int. 2005 Oct;25(5):984-6
references.pmid: 16162157
references.citation: Clin Gastroenterol Hepatol. 2009 Aug;7(8):906-9
references.pmid: 19447197
references.citation: Eur J Vasc Endovasc Surg. 2007 Feb;33(2):182-6
references.pmid: 17055755