SHM Converge Scientific Abstract ePoster Gallery-Under Pressure: A Rare Cause of Hemorrhage After Therapeutic Paracentesis

Pdf Summary

This case describes a 34-year-old woman with alcohol-related cirrhosis who developed recurrent hemorrhage after large-volume paracentesis (LVP). After two therapeutic taps, she had bloody ascites, severe anemia, worsening renal failure, and hemodynamic decline. Initial evaluation suggested possible bleeding from the left inferior epigastric artery, and angiography led to prophylactic embolization. However, her hemoglobin continued to fall, and later imaging showed subtle left lower quadrant extravasation as well as a hematocrit sign on point-of-care ultrasound, suggesting hemorrhage.<br /><br />Despite these findings, the true bleeding source was ultimately identified during liver transplant surgery. Operative findings revealed 4–5 liters of hemorrhagic ascites, extensive clot in the right upper quadrant, inflamed peritoneum with adhesions, and active bleeding near the gallbladder with avulsion of the liver capsule. The previously suspected inferior epigastric bleed was not confirmed intraoperatively.<br /><br />The authors emphasize that hemorrhage is a rare but serious complication of paracentesis and may occur not only from direct vessel injury but also because rapid removal of ascitic fluid reduces intra-abdominal pressure and can remove the tamponade effect on previously compressed vessels or varices. This case highlights the importance of not prematurely attributing post-paracentesis bleeding to the needle tract alone.<br /><br />Key lessons include:<br />- Consider multiple possible causes of hemorrhage after LVP.<br />- Use ultrasound to identify fluid pockets and avoid abdominal wall vessels.<br />- Recognize the hematocrit sign on ultrasound as a clue to bleeding.<br />- Persistent anemia after embolization should prompt further evaluation.<br /><br />Overall, the case illustrates a rare and dangerous mechanism of post-paracentesis hemorrhage and supports careful ultrasound-guided technique and broad diagnostic thinking.

Asset Subtitle

Nonye Onokalah

Meta Tag

Author List Erin M. Finn, Nonye Onokalah

Category Clinical Vignettes

Concept Bleeding

Concept Large-Volume Paracentesis

Concept Ultrasound

Concept Ultrasound Guidance

Concept Cirrhosis

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Nonye Onokalah

Track Adult

Keywords

paracentesis hemorrhage

large-volume paracentesis

cirrhosis

bloody ascites

inferior epigastric artery

embolization

hematocrit sign

ultrasound-guided paracentesis

liver transplant surgery

intra-abdominal bleeding

Bleeding

Large-Volume Paracentesis

Ultrasound

Ultrasound Guidance

Cirrhosis