Severe Intraperitoneal Hemorrhage from Pseudoaneurysm after a Large-volume Paracentesis, Successfully Treated with Microcoil Embolization

Soo Hyung Ryu; Dong II Kwon

doi:10.4166/kjg.2018.71.3.162

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Ryu and Kwon: Severe Intraperitoneal Hemorrhage from Pseudoaneurysm after a Large-volume Paracentesis, Successfully Treated with Microcoil Embolization

Case Report

Korean J Gastroenterol 2018;71(3):162-167.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.3.162

Severe Intraperitoneal Hemorrhage from Pseudoaneurysm after a Large-volume Paracentesis, Successfully Treated with Microcoil Embolization

Soo Hyung Ryu, Dong II Kwon¹

¹Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Soo Hyung Ryu, Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2270-0312, E-mail: rshdrryu@hanmail.net

Received 19 December 2017 Accepted 5 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Large-volume paracentesis-induced intraperitoneal hemorrhage due to pseudoaneurysm formation is rarely reported. Here, we present a 56-year-old man with alcoholic liver cirrhosis admitted for massive ascites. Large-volume paracentesis was performed. Three days later, he became pale and complained of dyspnea and abdominal distention with hypotension. Percutaneous iliac angiography revealed contrast media leakage from a branch of the left circumflex iliac artery with pseudoaneurysm. He was successfully treated with microcoil embolization. Several days later, ascitic fluid increased and large-volume paracentesis was performed again. Two days later, his hemoglobin level suddenly decreased. An abdominal computed tomography scan showed new active bleeding at the left lower lateral peritoneal cavity, just anterior to the metalic coils. Percutaneous iliac angiography revealed contrast media extravasation from a branch of the left inferior epigastric artery with formation of collateral vessel. Percutaneous embolization was successfully performed again. After coil embolization, there were no further bleeding episodes.

Keywords: Paracentesis, Pseudoaneurysm, Hemorrhage, Liver cirrhosis, Angiography

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Fig. 1.

The findings of abdominal CT and percutaneous iliac angiography. (A, B) CT shows active bleeding (arrow) on the left lower lateral peritoneum. (C, D) Percutaneous iliac angiography shows leakage of contrast media (arrow) from the branch of left superficial circumflex iliac artery. (E, F) After embolization with microcoils (arrow), no evidence of bleeding is seen the left iliac angiogram. CT, computed tomography.

Fig. 2.

The findings of abdominal CT and percutaneous iliac angiography. (A, B) CT shows a new active bleeding focus (arrow) on the left lower lateral peritoneal cavity anterior to metalic coils. (C) Extravasation of contrast media (arrow) from the branch of left inferior epigastric artery was shown. (D) Microcoil embolization (arrow) was performed.

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