Out of Sight Should Not Be Out of Mind: What Lurks Just Beneath the Surface of the Cirrhotic Abdominal Wall

Abstract

Paracentesis is a commonly performed procedure in both inpatient and outpatient settings. Useful for diagnostic and therapeutic purposes, prior studies have documented the inherent safety of this procedure. In proper hands, modern techniques such as the use of safety (Turkel) tipped needles and ultrasound localization have reduced the risk of major complications to less than 1%. Nevertheless, major bleeding remains a dreaded complication of this procedure, especially in patients with liver failure. Our historical experience has been that this complication is unpredictable, likely because of procedural injury to an abdominal wall artery or peritoneal varix. The authors report a case where the risk of vascular injury was mitigated using portable ultrasound and suggest a simple procedure for future risk reduction.