ACUTE HEMOPERITONEUM AFTER LARGE-VOLUME PARACENTESIS

Hemoperitoneum resulting from rupture of mesenteric varices is a rave complication of portal hypertension with a high mortality of up to 70% . This case report describes the symptoms, clinical course, and treatm ent of 4 patients with acute hemoperitoneum caused by mesenteric varic eal bleeding after large-volume paracentesis. Abdominal pain and/or he morrhagic shock developed in 4 patients (age, 48-68 years), admitted f or refractory ascites, 3 hours to 4 days after 1-4 large-volume parace nteses (>4000 mL). Duplex sonography, performed in 3 of the 4 patients before onset of bleeding, showed retrograde flow in the mesenteric ve ins, suggesting large-caliber mesenteric collateralization. Treatment consisted of surgical ligation followed by transjugular intrahepatic p ortosystemic shunt (TIPS) (2 patients) and emergency TIPS with emboliz ation of the bleeding vessel (1 patient). One patient died before any intervention could be initiated. In these 4 patients, the concurrence of large-volume paracentesis and hemoperitoneum suggests their causal relationship. The mechanism may be a sudden reduction in intraperitone al pressure increasing the pressure gradient across the wall of the me senteric varices, resulting in rupture and bleeding. The awareness of this complication may accelerate the diagnostic process and treatment.