Post-Paracentesis Hemoperitoneum From a Bleeding Mesenteric Varix: A Case Report on a Rare Presentation
Saad Ali Ansari1, Jasninder Singh Dhaliwal1, Aditya Desai1
1Internal Medicine, University of California Riverside School of Medicine, Riverside, USA.
Cureus
|February 21, 2022
Summary
Therapeutic paracentesis in patients with advanced cirrhosis can lead to rare, life-threatening mesenteric variceal bleeding. Early recognition and intervention are crucial for managing this serious complication and improving patient outcomes.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Procedures
Background:
- Decompensated liver cirrhosis is often associated with ascites and gastrointestinal bleeding.
- Alcohol abuse and hepatitis C infection are common causes of advanced liver disease.
- Upper gastrointestinal bleeding is a frequent complication in patients with cirrhosis.
Observation:
- A 53-year-old male with decompensated cirrhosis presented with hemorrhagic shock from an upper GI bleed.
- Following therapeutic paracentesis (removal of 6 L ascitic fluid), the patient experienced hemodynamic instability and a significant drop in hemoglobin.
- Imaging revealed massive hemoperitoneum attributed to a bleeding mesenteric varix.
Findings:
- Mesenteric varix rupture is an exceedingly rare complication following therapeutic paracentesis in advanced cirrhosis.
- The hemodynamic compromise and hemoperitoneum were directly linked to the paracentesis procedure in this case.
- This event highlights a critical, albeit uncommon, risk associated with ascites management in end-stage liver disease.
Implications:
- Early recognition of post-paracentesis hemodynamic instability is vital for prompt diagnosis and management.
- Awareness of this rare complication can guide clinicians in monitoring high-risk patients.
- Prompt intervention is essential to mitigate morbidity and mortality associated with mesenteric varix bleeding post-paracentesis.
