title: Making paracentesis safer: a proposal for the use of bedside abdominal and vascular ultrasonography to prevent a fatal complication.
abstract: Paracentesis has been considered a relatively safe procedure; however, hemorrhagic complications do occur and can be fatal, especially in the context of coagulopathy. We describe the case of a 47-year-old man with coagulopathy secondary to end-stage liver disease, whose hospital course was complicated by paracentesis-related hemoperitoneum leading to abdominal compartment syndrome. Emergent laparotomy revealed left inferior epigastric artery laceration caused by paracentesis. Despite operative control of bleeding, postoperatively, the patient developed severe metabolic acidosis, disseminated intravascular coagulation, and ultimately died from complications of hemorrhagic shock. Understanding key anatomic structures is essential for patient safety in the setting of paracentesis. While recognizing the lack of clinical studies demonstrating the effectiveness of ultrasonography use in paracentesis, we discuss the benefit of bedside abdominal ultrasonography to locate ascites and avoid intraabdominal structures, as well as vascular ultrasonography, during needle insertion to avoid abdominal wall vessels.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: sekiguchi.hiroshi@mayo.edu.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sekiguchi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jun
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Daniels
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D001808:Blood Vessels / Q000000981:diagnostic imaging; D058625:End Stage Liver Disease / Q000628:therapy; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000293:injuries*; D017809:Fatal Outcome; D006465:Hemoperitoneum / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D019095:Point-of-Care Systems / Q000639:trends*; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000517:prevention & control; D014463:Ultrasonography / Q000379:methods*