Korean J Gastroenterol.  2024 Apr;83(4):167-171. 10.4166/kjg.2024.030.

Successful Transcatheter Arterial Embolization of Abdominal Wall Hematoma from the Left Deep Circumflex Iliac Artery after Abdominal Paracentesis in a Patient with Liver Cirrhosis: Case Report and Literature Review

• Seo YE
• Lim CJ
• Lim JW
• Kim JS
• Oh HH
• Ma KY
• You GR
• Im CM
• Lee BC
• Joo YE

• KMID: 2555651
• DOI: http://doi.org/10.4166/kjg.2024.030

Abstract

The occurrence of an abdominal wall hematoma caused by abdominal paracentesis in patients with liver cirrhosis is rare. This paper presents a case of an abdominal wall hematoma caused by abdominal paracentesis in a 67-year-old woman with liver cirrhosis with a review of the relevant literature. Two days prior, the patient underwent abdominal paracentesis for symptom relief for refractory ascites at a local clinic. Upon admission, a physical examination revealed purpuric patches with swelling and mild tenderness in the left lower quadrant of the abdominal wall. Abdominal computed tomography revealed advanced liver cirrhosis with splenomegaly, tortuous dilatation of the para-umbilical vein, a large volume of ascites, and a large acute hematoma at the left lower quadrant of the abdominal wall. An external iliac artery angiogram showed the extravasation of contrast media from the left deep circumflex iliac artery. Embolization of the target arterial branches using N-butyl-2-cyanoacrylate was then performed, and the bleeding was stopped. The final diagnosis was an abdominal wall hematoma from the left deep circumflex iliac artery after abdominal paracentesis in a patient with liver cirrhosis.

Keyword

Paracentesis; Hemorrhage; Liver cirrhosis; Angiography

Figure

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  Fig. 1 Physical examination revealed purpuric patches with swelling, mild tenderness, and skin color changes in the left lower quadrant of the abdominal wall.

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  Fig. 2 (A, B) Enhanced axial CT images of the abdomen showing advanced liver cirrhosis with splenomegaly, tortuous dilatation of the para-umbilical vein (arrows in A), and a large volume of ascites. (C) Coronal CT image of the abdomen showing a large acute hematoma with suspicious contrast media extravasation (arrowheads) at the left lower quadrant of the abdominal wall.

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  Fig. 3 (A) External iliac artery angiogram showing extravasation of contrast media (arrow) from the left deep circumflex iliac artery. (B) Completion angiogram showing no further active bleeding after embolization of the target arterial branches with N-butyl-2-cyanoacrylate.

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