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Angioplasty

Bleed: Post paracentesis

Contributed by Dr. Ram Gurajala
13 September 2017

Case History:
  • 58 year old male with HCV cirrhosis, Esophageal varices, Ascites.
  • Hypotensive, intubated and on pressors.
  • Paracentesis was attempted from the left side
  • Resulted in drop in hemoglobin and bloody aspirate obtained.
  • Suspected intraperitoneal bleed.
  • CT angiogram performed
Case Differential Diagnosis:
  1. Arterial bleed
    • Inferior epigastric artery
    • Venous bleed
  2.  Management options:
    • Angiogram + embolization
    • Surgery
    • Conservative management
Case Outcome:
  • Active extravasation from left Inferior epigastric artery
  • Successfully embolized with small coils and particles
  • No further bleed
Case Diagnosis:
Post paracentesis bleed from left inferior epigastric artery
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