Korean J Gastroenterol.  2018 Mar;71(3):162-167. 10.4166/kjg.2018.71.3.162.

Severe Intraperitoneal Hemorrhage from Pseudoaneurysm after a Large-volume Paracentesis, Successfully Treated with Microcoil Embolization

• Ryu SH
• Kwon DI

• KMID: 2407673
• DOI: http://doi.org/10.4166/kjg.2018.71.3.162

Abstract

Large-volume paracentesis-induced intraperitoneal hemorrhage due to pseudoaneurysm formation is rarely reported. Here, we present a 56-year-old man with alcoholic liver cirrhosis admitted for massive ascites. Large-volume paracentesis was performed. Three days later, he became pale and complained of dyspnea and abdominal distention with hypotension. Percutaneous iliac angiography revealed contrast media leakage from a branch of the left circumflex iliac artery with pseudoaneurysm. He was successfully treated with microcoil embolization. Several days later, ascitic fluid increased and large-volume paracentesis was performed again. Two days later, his hemoglobin level suddenly decreased. An abdominal computed tomography scan showed new active bleeding at the left lower lateral peritoneal cavity, just anterior to the metalic coils. Percutaneous iliac angiography revealed contrast media extravasation from a branch of the left inferior epigastric artery with formation of collateral vessel. Percutaneous embolization was successfully performed again. After coil embolization, there were no further bleeding episodes.

Keyword

Paracentesis; Pseudoaneurysm; Hemorrhage; Liver cirrhosis; Angiography

MeSH Terms

Aneurysm, False*
Angiography
Ascites
Ascitic Fluid
Contrast Media
Dyspnea
Embolization, Therapeutic
Epigastric Arteries
Extravasation of Diagnostic and Therapeutic Materials
Hemorrhage*
Humans
Hypotension
Iliac Artery
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Middle Aged
Paracentesis*
Peritoneal Cavity
Contrast Media

Figure

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  Fig. 1. The findings of abdominal CT and percutaneous iliac angiography. (A, B) CT shows active bleeding (arrow) on the left lower lateral peritoneum. (C, D) Percutaneous iliac angiography shows leakage of contrast media (arrow) from the branch of left superficial circumflex iliac artery. (E, F) After embolization with microcoils (arrow), no evidence of bleeding is seen the left iliac angiogram. CT, computed tomography.

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  Fig. 2. The findings of abdominal CT and percutaneous iliac angiography. (A, B) CT shows a new active bleeding focus (arrow) on the left lower lateral peritoneal cavity anterior to metalic coils. (C) Extravasation of contrast media (arrow) from the branch of left inferior epigastric artery was shown. (D) Microcoil embolization (arrow) was performed.

Reference

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