HEMORRHAGIC COMPLICATIONS OF LARGE-VOLUME ABDOMINAL PARACENTESIS

The incidence of hemorrhagic complications from large volume paracente sis in patients with cirrhosis and portal hypertension is unknown, We have reviewed the cases of 179 outpatients undergoing large volume par acentesis at our institution during a 1-yr period, Of these 179 patien ts, four developed severe hemorrhagic complications requiring hospital admission and blood transfusion, Three of these patients developed in traperitoneal hemorrhage, one of which was localized to the paracentes is puncture site, One patient experienced an abdominal wall hematoma, localized by ultrasound, The symptoms and signs of hemorrhage became e vident anywhere from hours up to 1 wk after completion of the paracent esis procedure, The mechanism of delayed hemorrhage is not known but m ay relate to the rupture of large intra-abdominal venous collaterals i n these patients, The literature does not support a correlation betwee n degree of coagulopathy or thrombocytopenia and risk of bleeding in t his setting, To promote early detection of this potentially life-threa tening complication, a mechanism should exist for close outpatient fol low-up of patients after large volume paracentesis.